Annals Consult Guys - Hip Fracture Surgery: Any Gain With Spinal Versus General Anesthesia?
Authors: Howard H. Weitz, Geno J. Merli, Mark Neuman
Journal: Annals of Internal Medicine (2022)

Web ExclusivesJanuary 2022Annals Consult Guys - Hip Fracture Surgery: Any Gain With Spinal Versus General Anesthesia?FREEHoward H. Weitz, MD, Geno J. Merli, MD, and Mark Neuman, MD, MScHoward H. Weitz, MDThomas Jefferson University, Philadelphia, Pennsylvania (H.H.W., G.J.M.)Search for more papers by this author, Geno J. Merli, MDThomas Jefferson University, Philadelphia, Pennsylvania (H.H.W., G.J.M.)Search for more papers by this author, and Mark Neuman, MD, MScUniversity of Pennsylvania, Philadelphia, Pennsylvania (M.N.)Search for more papers by this authorAuthor, Article and Disclosure Informationhttps://doi.org/10.7326/W21-0002 CME/MOC SectionsSupplemental MaterialAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The Annals Consult Guys discuss whether the use of spinal versus general anesthesia improves patient outcomes following hip fracture surgery with Dr. Mark Neuman, the principal investigator for the REGAIN trial.For more videos from and information on Annals Consult Guys, visit go.annals.org/ConsultGuys. Comments0 CommentsSign In to Submit A Comment The Consult GuysJefferson University24 January 2022 Author’s response Dear Dr. Downs. Thank you for watching Consult Guys and for your questions. Because your inquiry related to the methods, analysis, and results of the REGAIN Trial we forwarded them directly to Dr. Mark Neuman, REGAIN Trial principal investigator and our Consult Guys guest. Here is Dr. Neuman’s response to your questions. -The Consult Guys Dr. Neuman’s response: “We estimated that a sample of 1,600 patients would provide 80% power to detect a 0.78 relative risk of the primary outcome among patients assigned to spinal versus general anesthesia. This calculation assumed an incidence of the primary outcome would occur in 34.2% of the patients in the general anesthesia group. The primary outcome occurred in a lower percentage of patients than had been anticipated when the trial was planned, which reduced power. Some patients in each group received an anesthesia type other than the one to which they were assigned; the most common reasons for this were inability to place a spinal block, clinician preference, and patient or proxy request. In our main analysis, all patients were analyzed in the groups to which they were assigned (i.e. intention-to-treat). We also conducted an instrumental variable analysis that accounted for non-adherence to the assigned treatment, which produced similar results to our main analysis.” John R Downs M.D.self/private practice19 January 2022 Negative trial adequately powered? With the trial being negative, was the study adequately powered? Did the primary outcome being a composite allow fewer patients to be enrolled? Why the drop in the assigned regional Anesthesia to 83% and general Anesthesia 95%? What happened to the 17% and 5% and how were those patients handled in the analyses? Author, Article and Disclosure InformationAffiliations: Thomas Jefferson University, Philadelphia, Pennsylvania (H.H.W., G.J.M.)University of Pennsylvania, Philadelphia, Pennsylvania (M.N.)Disclosures: Drs. Merli and Weitz report that they have no financial relationships or interests to disclose. Dr. Neuman reports support from the Patient-Centered Outcomes Research Institute. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=W21-0002.Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Stephanie Chang, MD, MPH, Deputy Editor, reports employment with the Agency for Healthcare Research and Quality, travel compensation from the Guidelines International Network, and participation in the Patient-Centered Outcomes Research Institute methodology committee. Vineet Chopra, MD, MSc, Deputy Editor, reports grants received from the Agency for Healthcare Research and Quality and royalties from UpToDate and Oxford University Press. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interests to disclose. Eliseo Guallar, MD, MPH, DrPH, Deputy Editor, Statistics, reports that he is employed at Johns Hopkins University. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center and consultancy with Boston Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports employment with the Perelman School of Medicine, University of Pennsylvania, and consultancies with the U.S. Food and Drug Administration and the State of Colorado. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics January 2022Volume 175, Issue 1Page: CG1 ePublished: 18 January 2022 Issue Published: January 2022 CopyrightCopyright © 2022 by American College of Physicians. All Rights Reserved.Loading ...