The Efficacy and Safety of Regional vs General Anesthesia in Elderly Surgical Patients: A Systematic Review

Abstract

Background: Elderly patients undergoing surgery, particularly for conditions like hip fractures, face heightened risks of postoperative complications such as delirium, mortality, and prolonged hospital stays due to age-related physiological changes and comorbidities. The choice between regional anaesthesia (RA), which includes spinal or epidural techniques, and general anaesthesia (GA) remains debated, with potential differences in efficacy and safety influencing outcomes like cognitive function, pain management, and overall recovery. Aim: This systematic review evaluates the efficacy and safety of RA compared to GA in elderly surgical patients, focusing on outcomes including mortality, postoperative delirium, complications, and hospital length of stay (LOS). It assesses diagnostic and management implications from recent studies to guide clinical practice. Methods: A systematic literature search was conducted using PubMed, Scopus, Web of Science, and Cochrane Library for peer-reviewed studies published between 2015 and 2025. Search terms included “regional anesthesia,” “general anesthesia,” “elderly patients,” “geriatric surgery,” “hip fracture,” “postoperative delirium,” and “mortality.” Randomized controlled trials (RCTs), cohort studies, and case-control studies evaluating RA versus GA in patients aged 65 years or older were included. Results: Eight studies involving 128,945 participants were analyzed, covering various surgical procedures like hip fracture repair and carotid endarterectomy. Key findings indicate that RA is often associated with lower risks of certain complications, such as pulmonary issues and ICU admissions, compared to GA. However, differences in mortality and delirium were inconsistent, with some studies showing no significant variance. Tailored approaches based on patient comorbidities improved safety profiles. Conclusion: RA demonstrates potential advantages in reducing specific postoperative complications and shortening LOS in elderly surgical patients, though evidence on mortality and delirium remains mixed. Individualized anesthesia selection, considering patient-specific factors, is recommended. Further high-quality RCTs are needed to refine protocols.