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Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults

Neuman, Mark D; Feng, Rui; Carson, Jeffrey L; Gaskins, Lakisha J; Dillane, Derek; Sessler, Daniel I; Sieber, Frederick; Magaziner, Jay; Marcantonio, Edward R; Mehta, Samir; Menio, Diane; Ayad, Sabry; Stone, Trevor; Papp, Steven; Schwenk, Eric S; Elkassabany, Nabil; Marshall, Mitchell; Jaffe, J Douglas; Luke, Charles; Sharma, Balram; Azim, Syed; Hymes, Robert A; Chin, Ki-Jinn; Sheppard, Richard; Perlman, Barry; Sappenfield, Joshua; Hauck, Ellen; Hoeft, Mark A; Giska, Mark; Ranganath, Yatish; Tedore, Tiffany; Choi, Stephen; Li, Jinlei; Kwofie, M Kwesi; Nader, Antoun; Sanders, Robert D; Allen, Brian F S; Vlassakov, Kamen; Kates, Stephen; Fleisher, Lee A; Dattilo, James; Tierney, Ann; Stephens-Shields, Alisa J; Ellenberg, Susan S
BACKGROUND:The effects of spinal anesthesia as compared with general anesthesia on the ability to walk in older adults undergoing surgery for hip fracture have not been well studied. METHODS:We conducted a pragmatic, randomized superiority trial to evaluate spinal anesthesia as compared with general anesthesia in previously ambulatory patients 50 years of age or older who were undergoing surgery for hip fracture at 46 U.S. and Canadian hospitals. Patients were randomly assigned in a 1:1 ratio to receive spinal or general anesthesia. The primary outcome was a composite of death or an inability to walk approximately 10 ft (3 m) independently or with a walker or cane at 60 days after randomization. Secondary outcomes included death within 60 days, delirium, time to discharge, and ambulation at 60 days. RESULTS:A total of 1600 patients were enrolled; 795 were assigned to receive spinal anesthesia and 805 to receive general anesthesia. The mean age was 78 years, and 67.0% of the patients were women. A total of 666 patients (83.8%) assigned to spinal anesthesia and 769 patients (95.5%) assigned to general anesthesia received their assigned anesthesia. Among patients in the modified intention-to-treat population for whom data were available, the composite primary outcome occurred in 132 of 712 patients (18.5%) in the spinal anesthesia group and 132 of 733 (18.0%) in the general anesthesia group (relative risk, 1.03; 95% confidence interval [CI], 0.84 to 1.27; P = 0.83). An inability to walk independently at 60 days was reported in 104 of 684 patients (15.2%) and 101 of 702 patients (14.4%), respectively (relative risk, 1.06; 95% CI, 0.82 to 1.36), and death within 60 days occurred in 30 of 768 (3.9%) and 32 of 784 (4.1%), respectively (relative risk, 0.97; 95% CI, 0.59 to 1.57). Delirium occurred in 130 of 633 patients (20.5%) in the spinal anesthesia group and in 124 of 629 (19.7%) in the general anesthesia group (relative risk, 1.04; 95% CI, 0.84 to 1.30). CONCLUSIONS:Spinal anesthesia for hip-fracture surgery in older adults was not superior to general anesthesia with respect to survival and recovery of ambulation at 60 days. The incidence of postoperative delirium was similar with the two types of anesthesia. (Funded by the Patient-Centered Outcomes Research Institute; REGAIN ClinicalTrials.gov number, NCT02507505.).
PMID: 34623788
ISSN: 1533-4406
CID: 5077372

Engaging patients as partners in a multicentre trial of spinal versus general anaesthesia for older adults

Hruslinski, Jennifer; Menio, Diane A; Hymes, Robert A; Jaffe, J Douglas; Langlois, Christine; Ramsey, Lolita; Gaskins, Lakisha J; Neuman, Mark D; Looke, Thomas; Bent, Sandra; Franco-Mora, Ariana; Hedrick, Pamela; Newbern, Matthew; Tadros, Rafik; Pealer, Karen; Marcantonio, Edward; Vlassakov, Kamen; Buckley, Carolyn; Gorbatov, Svetlana; Gosnell, James; Steen, Talora; Vafai, Avery; Zeballos, Jose; Cardenas, Louis; Berry, Ashley; Getchell, John; Quercetti, Nicholas; Sessler, Daniel I; Ayad, Sabry; Hassan, Manal; Ali, Assad; Bajracharya, Gauasan; Billow, Damien; Bloomfield, Michael; Elliott, Kavita; Hampton, Robert; He, Linda; Honar, Hooman; Khoshknabi, Dilara; Kim, Daniel; Minko, Paul; Morris, Adam; Niazi, Azfar; Nutcharoen, Tara; Roberts, Jeffrey; Saha, Partha; Salih, Ahmed; Skolaris, Alexis; Stang, Taylor; Strimbu, Victor; Templeton, Jesse; Volio, Andrew; Wang, Jiayi; Bolkus, Kelly; DeAngelis, Matthew; Dodson, Gregory; Gerritsen, Jeffrey; McEniry, Brian; Mitrev, Ludmil; Kwofie, Kwesi; Bonazza, Flynn; Lloyd, Vera; Panek, Izabela; Dabiri, Jared; Chavez, Chris; Craig, Jason; Davidson, Todd; Dietrichs, Chad; Fleetwood, Cheryl; Foley, Mike; Getto, Chris; Hailes, Susie; Hermes, Sarah; Hooper, Andy; Koener, Greg; Kohls, Kate; Law, Leslie; Lipp, Adam; Losey, Allison; Nelson, William; Nieto, Mario; Rogers, Pam; Rutman, Steve; Scales, Garrett; Sebastian, Barbara; Stanciu, Tom; Lobel, Gregg; Giampiccolo, Michelle; Herman, Dara; Kaufman, Margit; Murphy, Bryan; Pau, Clara; Puzio, Thomas; Veselsky, Marlene; Stone, Trevor; Apostle, Kelly; Boyer, Dory; Fan, Brenda Chen; Lee, Susan; Lemke, Mike; Merchant, Richard; Moola, Farhad; Payne, Kyrsten; Perey, Bertrand; Viskontas, Darius; Poler, Mark; D'Antonio, Patricia; Sheppard, Richard; Abdullah, Amer; Fish-Fuhrmann, Jamie; Giska, Mark; Fidkowski, Christina; Guthrie, Trent; Hakeos, William; Hayes, Lillian; Hoegler, Joseph; Nowak, Katherine; Hymes, Robert; Beck, Jeffery; Cuff, Jaslynn; Gaski, Greg; Haaser, Sharon; Holzman, Michael; Malekzadeh, A Stephen; Ramsey, Lolita; Schulman, Jeff; Schwartzbach, Cary; Sieber, Frederick; Azefor, Tangwan; Brown, Charles; Davani, Arman; Jaberi, Mahmood; Masear, Courtney; Sharma, Balram; Haider, Syed Basit; Chungu, Carolyn; Ebrahimi, Ali; Fikry, Karim; Gannon, Kerri; Marcantonio, Andrew; Pace, Meredith; Sanders, David; Clarke, Collin; Lawendy, Abdel; Schwartz, Gary; Garg, Mohit; Kim, Joseph; Marshall, Mitchell; Caurci, Juan; Commeh, Ekow; Cuevas, Randy; Cuff, Germaine; Franco, Lola; Furguiele, David; Giuca, Matthew; Allman, Melissa; Barzideh, Omid; Cossaro, James; D'Arduini, Armando; Farhi, Anita; Gould, Jason; Kafel, John; Patel, Anuj; Peller, Abraham; Reshef, Hadas; Safur, Mohammed; Toscano, Fiore; Tedore, Tiffany; Akerman, Michael; Brumberger, Eric; Clark, Sunday; Friedlander, Rachel; Jegarl, Anita; Lane, Joseph; Lyden, John P; Mehta, Nili; Murrell, Matthew T; Painter, Nathan; Ricci, William; Sbrollini, Kaitlyn; Sharma, Rahul; Steel, Peter A D; Steinkamp, Michele; Weinberg, Roniel; Wellman, David Stephenson; Nader, Antoun; Fitzgerald, Paul; Ritz, Michaela; Papp, Steven; Bryson, Greg; Craig, Alexandra; Farhat, Cassandra; Gammon, Braden; Gofton, Wade; Harris, Nicole; Lalonde, Karl; Liew, Allan; Meulenkamp, Bradley; Sonnenburg, Kendra; Wai, Eugene; Wilkin, Geoffrey; Donegan, Derek; Dinh, Cassandra; Elkassabany, Nabil; Horan, Annamarie; Mehta, Samir; Troxell, Karen; Alderfer, Mary Ellen; Brannen, Jason; Cupitt, Christopher; Gerhart, Stacy; McLin, Renee; Sheidy, Julie; Yurick, Katherine; Carson, Jeffrey; Chen, Fei; Dragert, Karen; Kiss, Geza; Malveaux, Halina; McCloskey, Deborah; Mellender, Scott; Mungekar, Sagar S; Noveck, Helaine; Sagebien, Carlos; Perlman, Barry; Biby, Luat; McKelvy, Gail; Richards, Anna; Azim, Syed; Abola, Ramon; Ayala, Brittney; Halper, Darcy; Mavarez, Ana; Choi, Stephen; Awad, Imad; Flynn, Brendan; Henry, Patrick; Jenkinson, Richard; Kaustov, Lilia; Lappin, Elizabeth; McHardy, Paul; Singh, Amara; Hauck, Ellen; Donnelly, Joanne; Gonzalez, Meera; Haydel, Christopher; Livelsberger, Jon; Pazionis, Theresa; Slattery, Bridget; Vazquez-Trejo, Maritza; Schwenk, Eric; Baratta, Jaime; Deiling, Brittany; Deschamps, Laura; Glick, Michael; Katz, Daniel; Krieg, James; Lessin, Jennifer; Torjman, Marc; Chin, Ki Jinn; Jin, Rongyu; Salpeter, Mary Jane; Powell, Mark; Simmons, Jeffrey; Lawson, Prentiss; Kukreja, Promil; Graves, Shanna; Sturdivant, Adam; Bryant, Ayesha; Crump, Sandra Joyce; Dillane, Derek; Taylor, Michael; Verrier, Michelle; Applegate, Richard; Arias, Ana; Pineiro, Natasha; Uppington, Jeffrey; Wolinsky, Phillip; Sappenfield, Joshua; Gunnett, Amy; Hagen, Jennifer; Harris, Sara; Hollen, Kevin; Holloway, Brian; Horodyski, Mary Beth; Pogue, Trevor; Ramani, Ramachandran; Smith, Cameron; Woods, Anna; Warrick, Matthew; Flynn, Kelly; Mongan, Paul; Ranganath, Yatish; Fernholz, Sean; Ingersoll-Weng, Esperanza; Marian, Anil; Seering, Melinda; Sibenaller, Zita; Stout, Lori; Wagner, Allison; Walter, Alicia; Wong, Cynthia; Magaziner, Jay; Orwig, Denise; Brown, Trina; Dattilo, Jim; Ellenberg, Susan; Feng, Rui; Fleisher, Lee; Gaskins, Lakisha; Goud, Maithri; Helker, Chris; Mezenghie, Lydia; Montgomery, Brittany; Preston, Peter; Stephens, Alisa; Schwartz, J Sanford; Tierney, Ann; Weber, Ramona; Chelly, Jacques; Goel, Shiv; Goncz, Wende; Kawabe, Touichi; Khetarpal, Sharad; King, Kevin; Kunkel, Frank; Luke, Charles; Monroe, Amy; Shick, Vladislav; Silipo, Anthony; Stehle, Caroline; Szabo, Katherine; Yennam, Sudhakar; Hoeft, Mark; Breidenstein, Max; Dominick, Timothy; Friend, Alexander; Mathews, Donald; Lennertz, Richard; Akere, Helen; Balweg, Tyler; Bo, Amber; Doro, Christopher; Goodspeed, David; Lang, Gerald; Parker, Maggie; Rettammel, Amy; Roth, Mary; Sanders, Robert; White, Marissa; Whiting, Paul; Allen, Brian; Baker, Tracie; Craven, Debra; McEvoy, Matt; Turnbo, Teresa; Kates, Stephen; Morgan, Melanie; Willoughby, Teresa; Weigel, Wade; Auyong, David; Fox, Ellie; Welsh, Tina; Jaffe, J Douglas; Cusson, Bruce; Dobson, Sean; Edwards, Christopher; Harris, Lynette; Henshaw, Daryl; Johnson, Kathleen; McKinney, Glen; Miller, Scott; Reynolds, Jon; Turner, Jimmy; VanEenenaam, David; Weller, Robert; Akhtar, Shamsuddin; Blessing, Marcelle; Johnson, Chanel; Kampp, Michael; Kunze, Kimberly; Li, Jinlei; O'Connor, Mary; Treggiari, Miriam
Engaging patients-defined broadly as individuals with lived experience of a given condition, family members, caregivers, and the organisations that represent them-as partners in research is a priority for policymakers, funders, and the public. Nonetheless, formal efforts to engage patients are absent from most studies, and models to support meaningful patient engagement in clinical anaesthesia research have not been previously described. Here, we review our experience in developing and implementing a multifaceted patient engagement strategy within the Regional Versus General Anesthesia for Promoting Independence After Hip Fracture (REGAIN) surgery trial, an ongoing randomised trial comparing spinal vs general anaesthesia for hip fracture surgery in 1600 older adults across 45 hospitals in the USA and Canada. This strategy engaged patients and their representatives at both the level of overall trial oversight and at the level of individual recruiting sites. Activities spanned a continuum ranging from events designed to elicit patients' input on key decisions to longitudinal collaborations that empowered patients to actively participate in decision-making related to trial design and management. Engagement activities were highly acceptable to participants and led to concrete changes in the design and conduct of the REGAIN trial. The REGAIN experience offers a model for future efforts to engage patients as partners in clinical anaesthesia research, and highlights potential opportunities for investigators to increase the relevance of anaesthesia studies by incorporating patient voices and perspectives into the research process.
PMID: 33279102
ISSN: 1471-6771
CID: 5022622

Platelet aggregation and coagulation factors in orthopedic surgery

Oberweis, Brandon S; Cuff, Germaine; Rosenberg, Andrew; Pardo, Luis; Nardi, Michael A; Guo, Yu; Dweck, Ezra; Marshall, Mitchell; Steiger, David; Stuchin, Steven; Berger, Jeffrey S
Hemostasis is a major concern during the perioperative period. Changes in platelet aggregation and coagulation factors may contribute to the delicate balance between thrombosis and bleeding. We sought to better understand perioperative hemostasis by investigating the changes in platelet aggregation and coagulation factors during the perioperative period. We performed a prospective cohort analysis of 70 subjects undergoing non-emergent orthopedic surgery of the knee (n = 28), hip (n = 35), or spine (n = 7) between August 2011 and November 2011. Plasma was collected preoperatively (T1), 1-h intraoperatively (T2), 1-h (T3), 24-h (T4) and 48-h (T5) postoperatively. Platelet function testing was performed using whole blood impedance aggregometry. Coagulation assays were performed for factor VII, factor VIII, von Willebrand Factor (vWF), and fibrinogen. Of the 70 patients, mean age was 64.1 +/- 9.8 years, 61 % were female, and 74 % were Caucasian. Platelet activity decreased until 1 h postoperatively and then significantly increased above baseline at 24- and 48-h postoperatively. Compared to baseline, coagulation factors decreased intraoperatively. Factor VII activity continued to decrease, while FVIII, vWF, and fibrinogen all increased above baseline postoperatively. The results of our study indicate significant changes in platelet activity and coagulation factors during the perioperative period. Both platelet activity and markers of coagulation decrease during the intraoperative period and then some increase postoperatively. These changes may contribute to the hypercoagulabity and/or bleeding risk that occurs in the perioperative period. Future prospective studies aimed at correlating hemostatic changes with perioperative outcomes are warranted.
PMID: 24874897
ISSN: 0929-5305
CID: 1018852

Changes in hemostasis during the perioperative period of orthopedic surgery [Meeting Abstract]

Oberweis, B.; Nardi, M. A.; Cuff, G.; Rosenberg, A.; Pardo, L.; Guo, Y.; Marshall, M.; Steiger, D.; Stuchin, S.; Berger, J. S.
ISI:000331833602402
ISSN: 1538-7933
CID: 875242

Three partial-task simulators for teaching ultrasound-guided regional anesthesia

Rosenberg, Andrew D; Popovic, Jovan; Albert, David B; Altman, Robert A; Marshall, Mitchell H; Sommer, Richard M; Cuff, Germaine
ABSTRACT: Simulation-based training is becoming an accepted tool for educating physicians before direct patient care. As ultrasound-guided regional anesthesia (UGRA) becomes a popular method for performing regional blocks, there is a need for learning the technical skills associated with the technique. Although simulator models do exist for learning UGRA, they either contain food and are therefore perishable or are not anatomically based. We developed 3 sonoanatomically based partial-task simulators for learning UGRA: an upper body torso for learning UGRA interscalene and infraclavicular nerve blocks, a femoral manikin for learning UGRA femoral nerve blocks, and a leg model for learning UGRA sciatic nerve blocks in the subgluteal and popliteal areas
PMID: 22189577
ISSN: 1532-8651
CID: 147708

The educational value of peripheral nerve block workshops [Meeting Abstract]

Rosenberg AD; Connell F; Spessot G; Marshall M; Albert D
ORIGINAL:0004988
ISSN: 0003-3022
CID: 47339

Are peripheral nerve block workshops a valuable educational tool? [Meeting Abstract]

Rosenberg, AD; Bernstein, RL; Albert, DB; Marshall, MH; Altman, RA; Thomas, SJ
ISI:A1997WF78000206
ISSN: 0003-2999
CID: 53301

Anterior approach to the sciatic nerve a radiographic correlation

Rosenberg AD; Bernstein R; Marshall MH; Albert DB
ORIGINAL:0004840
ISSN: 1078-4500
CID: 45601

Do anesthesiologists practice proper infection control precautions? [Meeting Abstract]

Rosenberg AD; Bernstein RL; Ramanathan S; Albert DB; Marshall MH
ORIGINAL:0005030
ISSN: 0003-3022
CID: 47381