American Society of Regional Anesthesia and Pain Medicine August 2016 - 13


regard to patient-centered outcomes that have been largely ignored
by prior work, such as functional recovery and patient satisfaction
after surgery.
To begin to address these knowledge gaps, my colleagues and
I have undertaken the REGAIN Trial (Regional versus General
Anesthesia for Promoting Independence after Hip Fracture,
ClinicalTrials.gov identifier NCT02507505), a major new multicenter
effort to compare patient-centered outcomes at up to 1 year among
patients randomized to receive spinal versus general anesthesia for
hip fracture surgery. Funded by the United States Patient-Centered
Outcomes Research Institute, REGAIN will randomize 1,600 patients
over a 4-year period to pragmatic, "real-world" protocols for
spinal and general anesthesia at more than 35 sites in the United
States and Canada. When completed in 2020, REGAIN will yield
new information on the relative advantages and disadvantages
of the two most commonly used anesthesia techniques for hip
fracture in terms of medical morbidity and mortality, as well as a
range of outcomes, including metrics of functional recovery, pain
experiences, and satisfaction with care. In so doing, REGAIN will
provide critical information to fill in existing evidence gaps and
improve the ability of hip fracture patients and their families to
make informed decisions about their anesthesia care.
A key goal of REGAIN is not only to add to existing randomized and
nonrandomized evidence regarding the pros and cons of differing
anesthetic approaches for hip fracture, but also, we hope, to inspire
clinicians and researchers within anesthesiology to pursue their
own efforts to obtain high-quality data to improve care through
collaborative pragmatic randomized trials. Ultimately, by providing
better information to guide clinicians' and patients' care choices,
our hope is that REGAIN and similar efforts can increase the overall
patient-centeredness of anesthesia care for hip fracture patients,
while also helping to improve clinical outcomes.

3.	 Tajeu GS, Delzell E, Smith W, et al. Death, debility, and destitution following hip
fracture. J Gerontol A Biol Sci Med Sci 2014;69:346-353.
4.	 Hung WW, Egol KA, Zuckerman JD, Siu AL. Hip fracture management: tailoring
care for the older patient. JAMA 2012;307:2185-2194.
5.	 Parker MJ, Handoll HH, Griffiths R. Anaesthesia for hip fracture surgery in adults.
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6.	 U.K. National Clinical Guideline Centre. The management of hip fracture in
adults. London, United Kingdom: National Clinical Guideline Centre. Available at:
www.ncgc.ac.uk. Accessed June 10, 2016.
7.	 Neuman MD, Silber JH, Elkassabany NM, Ludwig JM, Fleisher LA. Comparative
effectiveness of regional versus general anesthesia for hip fracture surgery in
adults. Anesthesiology 2012;117:72-92.
8.	 Neuman MD, Rosenbaum PR, Ludwig JM, Zubizarreta JR, Silber JH. Anesthesia
technique, mortality, and length of stay after hip fracture surgery. JAMA
2014;311:2508-2517.
9.	 Chu CC, Weng SF, Chen KT, et al. Propensity score-matched comparison of
postoperative adverse outcomes between geriatric patients given a general or a
neuraxial anesthetic for hip surgery: a population-based study. Anesthesiology
2015;123:136-147. doi:10.1097/ALN.0000000000000695.
10.	 Fields AC, Dieterich JD, Buterbaugh K, Moucha CS. Short-term complications
in hip fracture surgery using spinal versus general anaesthesia. Injury
2015;46:719-723.
11.	 White SM, Moppett IK, Griffiths R. Outcome by mode of anaesthesia for hip
fracture surgery: an observational audit of 65 535 patients in a national dataset.
Anaesthesia 2014;69:224-230.
12.	 White SM, Moppett IK, Griffiths R, et al. Secondary analysis of outcomes after
11,085 hip fracture operations from the prospective UK Anaesthesia Sprint Audit
of Practice (ASAP-2). Anaesthesia 2016:71:506-514. doi: 10.1111/anae.13415.
13.	 Patorno E, Neuman MD, Schneeweiss S, Mogun H, Bateman BT. Comparative
safety of anesthetic type for hip fracture surgery in adults: retrospective cohort
study. BMJ 2014;348:g4022.
14.	 Boulton C, Currie C, Griffiths R, et al. National Hip Fracture Database:
Anaesthesia Sprint Audit of Practice. London, United Kingdom: Royal College of
Physicians; 2014.
15.	 Basques BA, Bohl DD, Golinvaux NS, Samuel AM, Grauer JG. General versus
spinal anaesthesia for patients aged 70 years and older with a fracture of the
hip. Bone Joint J 2015;97-B:689-695.

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2016

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Table of Contents for the Digital Edition of American Society of Regional Anesthesia and Pain Medicine August 2016
