Comparing perioperative complications and recovery outcomes of neuraxial versus general anesthesia in hip fracture surgery: A systematic review and meta-analysis

ABSTRACT

To compare perioperative complications and recovery outcomes between neuraxial and general anesthesia in adult patients undergoing hip fracture surgery. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following PRISMA guidelines. MEDLINE, Embase, CENTRAL, and Scopus were searched from 2000 to April 25, 2026. Studies comparing neuraxial and general anesthesia were included. Outcomes included mortality (in-hospital, 30-day, 90-day, 1-year), intraoperative hypotension, postoperative delirium, acute coronary syndrome (ACS), pneumonia, acute kidney injury (AKI), length of hospital stay, and postoperative nausea and vomiting (PONV). Random-effects models were used to calculate pooled effect estimates. Nineteen RCTs (n = 4,742) were included. No significant differences were observed between neuraxial and general anesthesia for mortality at any time point, postoperative delirium, ACS, pneumonia, or PONV. Neuraxial anesthesia was associated with a lower risk of intraoperative hypotension (RR 0.55, 95% CI 0.40–0.77) and AKI (RR 0.57, 95% CI 0.38–0.84), and shorter length of hospital stay (MD − 0.58 days, 95% CI − 1.08 to − 0.07). Heterogeneity was substantial for some outcomes. Neuraxial anesthesia decreases the risk of intraoperative hypertension and acute kidney injury in comparison to general anesthesia in patients undergoing hip fracture repair.