A PCORI-funded study can help older adults and their caregivers discuss anesthesia options for hip fracture surgery with their doctors.
Each year, more than 300,000 older adults in the United States fracture a hip. Hip fractures can cause serious problems for older adults. They may have pain, no longer be able to walk on their own, or need extra help with daily care. This need for extra help might mean staying at a skilled nursing center during recovery or moving to a nursing home.
Most people need surgery to fix a hip fracture. A doctor called an anesthesiologist gives patients medicine to keep them from feeling pain during surgery. The two types of anesthesia that are used most often in hip fracture surgery are:
Findings
A PCORI-funded study found no major differences in the recovery of patients who received spinal anesthesia and patients who received general anesthesia.
The two types of anesthesia did not differ in the combined outcome measure of not being able to walk or dying within two months after surgery. (The research team included death as part of the outcome to be sure they didn’t only look at patients who lived after surgery.) For both types of anesthesia, about 18 percent of patients either couldn’t walk or had died within two months of surgery.
➤ Spinal anesthesia. The anesthesiologist numbs the lower body by injecting medicine into the spine to block pain. Patients may also choose to be given medicine that puts them into a light sleep so that they are not aware during surgery.
➤ General anesthesia. The anesthesiologist gives patients medicine through a vein or a face mask. The patient enters a deep, sleep-like state and does not feel pain. Patients who receive general anesthesia need a breathing tube and a machine to help them breathe during the surgery.
In the PCORI-funded REGAIN study, the research team looked at how the two types of anesthesia affected recovery from hip fracture surgery. The team assigned patients by chance to receive either spinal anesthesia or general anesthesia.
For most patients, both spinal and general anesthesia are safe options. But some patients may need to avoid one or the other for different reasons. For example, one type of anesthesia may interact with medicines a patient is taking and cause problems before, during, or after surgery. For others, health problems such as heart disease, joint or bone disease, or dementia may limit the type of anesthesia they can have.
Other Findings
Patients who received the two types of anesthesia did not differ in their:
➤ Need to use a walker or cane to walk.
➤ Overall health up to one year after surgery.
➤ Long-term pain.
➤ Satisfaction with their care.
Also, the research team found no differences in:
➤ The number of patients who returned to where they were living before surgery.
➤ The length of patients’ hospital stays.
➤ The number of patients who experienced confusion or were not aware of their surroundings after surgery.
➤ The number of patients who had other health problems in the hospital.
Pain after surgery was also similar for patients who had both types of anesthesia. Patients who received spinal anesthesia had slightly more pain in the first 24 hours and took slightly more pain medicines after surgery, but these differences were small.
Talking to Your Clinician About Anesthesia for Hip Fracture Surgery
Shortly before your hip fracture surgery, you will meet with your anesthesiologist and surgeon. You and your caregivers may wish to discuss with them which anesthesia may be right for you, especially if you have a strong preference for using one type of anesthesia over the other.
Questions to ask may include:
➤ Which types of anesthesia are safe for me given my health conditions and the medicines I take?
➤ What side effects should I expect?
➤ If I have spinal anesthesia, I still want to be in a light sleep. What kinds of medicines will you use to do that? What side effects might these medicines have?
➤ What should I expect during my recovery based on the type of anesthesia I receive?
➤ How will my pain be managed after surgery?
About the Study
In this study, the research team assigned 1,600 patients by chance to receive either spinal or general anesthesia for hip fracture surgery. Patients in the study were ages 50 and older. All received care at one of 46 hospitals in the United States and Canada.
During the first three days after surgery, the research team asked patients about their pain and about how satisfied they were with the care they had received. The team also talked with patients by phone several times up to one year after surgery. During these calls, the team asked patients if they could walk at least 10 feet without help from another person, where they were living, and what their pain and overall health were like. The team looked at patient health records for information on patients’ length of hospital stay, complications, and death.
Read more about this study at www.pcori.org/Neuman459
SOURCES
© 2011–2025 Patient-Centered Outcomes Research Institute. “Comparing Two Types of Anesthesia for Hip Fracture Surgery -- The REGAIN Trial.” Updated May 8, 2025. www.pcori.org/Neuman459
Neuman MD, Feng R, Carson JL, et al. Spinal anesthesia or general anesthesia for hip surgery in older adults. N Engl J Med. 2021;385(22):2025-2035. doi:10.1056/NEJMoa2113514
The information in this publication is not intended to be a substitute for professional medical advice. This update summarizes findings from a PCORI research award to the University of Pennsylvania.
Posted: July 14, 2025