In the October 2021 issue of NEJM, Neuman and colleagues reported no difference in the major outcome of patients with hip fractures who were randomized to receive spinal or general anesthesia. In a large prospective study that included 1,600 patients with hip fracture, the study concluded that spinal was not superior to general anesthesia with respect to survival and recovery of ambulation at 60 days, or the incidence of postoperative delirium. In this video with expert clinicians' testimonials, Dr. Hadzic argues that the methodology was biased against spinal anesthesia. He explains how the inclusion bias of healthier population, mandatory intraoperative sedation for patients having spinal anesthesia, the lack of standardization of the premedication for positioning for spinal, and the apparent lack of the regional anesthesia skills (15% failure to administer spinal) skewed the outcome. Likewise, the selection of primary outcome variables missed capturing the ubiquitously observed advantages of spinal anesthesia in hip fracture patients who often present for surgery with severe comorbidities where avoidance of general anesthesia is beneficial. Watch the video as Dr. Hadzic breaks the study down, to make your own opinion of whether this study’s findings are relevant to your own practice.

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