Effects of General Anesthesia Versus Spinal Anesthesia on Early Postoperative Cognition and 30-Day Activities of Daily Living in Elderly Hip Fracture Patients in a Chinese Plateau Region.

OBJECTIVE: This study aimed to evaluate the differential effects of general anesthesia (GA) and spinal anesthesia (SA) on postoperative cognitive dysfunction (POCD) and daily living (ADL) in geriatric undergoing hip fracture surgery in a plateau region of China. METHODS: This randomized controlled trial enrolled 161 patients undergoing hip fracture surgery at The Third People's Hospital of Xining between August 2022 and June 2024. Subjects were assigned to a GA group (n=80) and an SA group (n=81). The Chinese version of the ADL was applied to evaluate functional ability preoperatively and 30 days postoperatively. Cognitive and emotional states were assessed preoperatively, as well as at 7 and 30 days after surgery, using the Chinese Mini Mental Status (CMMS), the Montreal Cognitive Assessment (MoCA), and the Beck Depression Inventory‑II (BDI‑II). Postoperative delirium, length of hospital stay, hospitalization expenses, and 30‑day readmission rate were also documented as secondary outcome measures. RESULTS: At 30 days postoperatively, most items of the Physical Self‑Maintenance Scale (PSMS) and Activities of Daily Living (IADL) scale showed no significant differences between groups (P >0.05). Regarding neuropsychological assessments, CMMS scores showed no significant differences at any time point. MoCA scores were nominally higher in the SA group at 7 days postoperatively (unadjusted P = 0.020), but this difference did not remain significant after multiplicity adjustment (adjusted P > 0.05), nor was it sustained at 30 days. Similarly, BDI‑II scores were nominally higher in the SA group at 30 days (unadjusted P = 0.020), but this difference was not significant after correction for multiple comparisons. There were no statistically significant differences in postoperative delirium incidence, length of hospital stay, hospitalization costs, or 30‑day readmission rates between the groups (all P > 0.05). CONCLUSION: GA and SA have overall similar effects on postoperative cognitive function, activities of daily living, and short‑term prognosis in elderly hip fracture patients. Both anesthetic techniques appear safe and effective, supporting individualized clinical decision‑making in this population. CLINICAL REGISTRATION: Chinese Clinical Trial Registry (Registration No: ChiCTR2000036756; Registration Date: August 25, 2020).