A multicenter retrospective study on anesthesia methods and their impact on neurocognitive outcomes and other complications in elderly patients undergoing hemiarthroplasty.

Objective: To evaluate the effects of various anesthesia techniques on perioperative neurocognitive disorders (PND) and other postoperative complications in elderly patients undergoing hemiarthroplasty for hip fractures. Methods: This multicenter retrospective observational study analyzed 5,005 elderly patients (≥65 years) with hip fractures who underwent hemiarthroplasty and had complete perioperative clinical data. Patients were categorized into five anesthesia groups: a, Combined intravenous-inhalation anesthesia (IVA + IHA); b, IVA + IHA with peripheral nerve block (PNB); c, Intravenous anesthesia (IVA) with PNB; d, Spinal anesthesia (SA); e, SA with PNB. Postoperative delirium (POD) was assessed twice daily during the first 3 postoperative days using the Confusion Assessment Method (CAM). Delayed neurocognitive recovery (DNR) was evaluated via telephone follow-up on postoperative day 7. Other postoperative complications, as well as 30-day and 6-month mortality rates, were systematically recorded. Results: The analysis revealed no significant differences in POD incidence among the first three anesthesia groups (a/b/c) or between the last two groups (d/e) ( Conclusion: These findings suggest that regional anesthesia may be associated with lower early POD and pulmonary infection rates. Further prospective randomized controlled trials are needed to validate these results.