Perioperative loss of the psoas major muscle area index in elderly patients with hip fracture: spinal anesthesia versus general anesthesia-a retrospective cohort study.

Purpose: In hip fracture patients aged ≥ 80 years, we investigated whether the perioperative reduction in the psoas major muscle index (PMI) for spinal anesthesia was less than that for general anesthesia.

Methods: A total of 262 patients surgically treated for intertrochanteric or femoral neck fractures between August 2015 and August 2022 were enrolled. After adjusting for propensity score matching, 50 patients were included in this analysis. After matching, patients were divided into those receiving spinal or general anesthesia. We measured the psoas major muscle area (PMA) by adjusting for the patient's height as PMA (cm) divided by height (m) squared. The adjusted PMA was defined as the PMI. We calculated the variability in PMI (ΔPMI) before and after surgery. The primary outcome was the proportion of patients with a > 10% reduction in ΔPMI. The secondary outcomes were the mean ΔPMI and estimated factors affecting the postoperative reduction in the PMI. We compared the primary and secondary outcomes between spinal and general anesthesia.

Results: The proportion with a > 10% reduction in ΔPMI did not differ between spinal and general anesthesia (36.0% vs. 40.0%, odds ratio:1.19, 95% CI:0.38-3.72, p = 0.31). The ΔPMI did not differ between spinal and general anesthesia (- 8.7% ± 7.9% vs. - 8.9% ± 8.3%, p = 0.93). The factors affecting the postoperative reduction in the PMI were male sex, preoperative non-sarcopenia, and intramedullary nailing.

Conclusion: There was no significant difference in ΔPMI between hip fracture patients ≥ 80 years of age receiving spinal versus general anesthesia undergoing surgical treatment.