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Spinal anesthesia generally is assumed to be safer than general anesthesia for patients at high risk for perioperative morbidity and mortality. In this trial, conducted at 46 hospitals in the U.S. and Canada, 1600 patients (mean age, 78) with intertrochanteric, subtrochanteric, or femoral neck fractures were randomized to undergo surgical repair with spinal or general anesthesia. About 15% of patients in both groups had coronary disease, and 15% had chronic lung disease.
Compared with patients who received general anesthesia, patients randomized to spinal anesthesia had similar rates of the primary outcome (a composite of death and inability to walk a short distance) at 60 days (≈18% in each group). Mortality (≈4%), in-hospital delirium (≈20…