Journal of Anesthesiology and Reanimation Specialists’ Society · Jul 30, 2026
The Impact of General and Spinal Anesthesia on Mortality in Hip Fracture Surgery: A Retrospective Cohort Study Using Multivariable Logistic Regression
By Baydemir AE, Tontu F, KARADOĞAN BF et al.
Objective: Hip fracture surgery is associated with considerable early mortality, particularly among older and frail patients.Although anesthetic technique is considered a potentially modifiable perioperative factor, randomized trials have not consistently demonstrated a survival advantage of spinal over general anesthesia.In real-world practice, anesthetic choice is often influenced by baseline frailty and comorbidity burden, which may complicate the interpretation of associations between anesthesia type and outcomes.Method: This retrospective observational cohort study included adult patients who underwent hip fracture surgery at a tertiary care center between January 2021 and May 2025.Patients were categorized according to anesthetic technique as spinal or general anesthesia.The primary outcome was in-hospital mortality.Multivariable logistic regression analysis was performed to identify independent predictors of mortality, including anesthetic technique, age-adjusted Charlson Comorbidity Index, and physiological markers of frailty.Results: A total of 665 patients were included; 514 received spinal anesthesia and 151 received general anesthesia.In-hospital mortality was higher in the general anesthesia group than in the spinal anesthesia group (7.9% vs. 3.7%; p=0.037).However, after adjustment for comorbidity burden using the age-adjusted Charlson Comorbidity Index, the association between general anesthesia and in-hospital mortality was attenuated and was no longer statistically significant (adjusted OR 1.68; 95% CI 0.84-3.38).In contrast, higher Charlson Comorbidity Index score, lower preoperative serum albumin level, and dialysis dependence remained strong independent predictors of in-hospital mortality.Conclusion: In this real-world cohort of patients undergoing hip fracture surgery, the association between general anesthesia and increased in-hospital mortality appeared to be largely explained by underlying frailty rather than a direct effect of anesthetic tech- The Impact of General and Spinal Anesthesia on Mortality in Hip Fracture Surgery: A Retrospective Cohort Study Using Multivariable Logistic RegressionKalça Kırığı Cerrahisinde Genel ve Spinal Anestezinin Mortalite Üzerine Etkisi: Çok Değişkenli Lojistik Regresyon Kullanılarak Yapılmış Retrospektif Kohort Çalışması