Overview
This prospective observational study aims to compare total intravenous anesthesia (TIVA) with sevoflurane-based inhalational anesthesia in patients aged 65 years and older undergoing hip fracture surgery under general anesthesia. The study will evaluate postoperative quality of recovery using the Quality of Recovery-40 (QoR-40) questionnaire and cognitive outcomes, including postoperative delirium and cognitive status. Pain scores, opioid consumption, recovery room stay, postoperative complications, and patient satisfaction will also be recorded. The anesthesia technique will be determined by the attending anesthesiologist as part of routine clinical practice, and the researchers will not interfere with the choice of anesthesia.
Description
This is a prospective, single-center observational study involving patients aged 65 years and older who undergo hip fracture surgery under general anesthesia. Patients will be followed according to the anesthesia technique used during routine clinical care: propofol-based total intravenous anesthesia (TIVA) or sevoflurane-based inhalational anesthesia. No intervention or modification of routine anesthesia management will be performed by the investigators.
Demographic characteristics, ASA physical status, comorbidities, preoperative Quality of Recovery-40 (QoR-40) scores, and Mini-Mental State Examination (MMSE) scores will be recorded. Intraoperative data, including anesthesia and surgery duration, hemodynamic parameters, extubation time, and anesthetic and analgesic drug consumption, will also be collected.
On postoperative day 1, QoR-40, numerical rating scale (NRS) pain scores, and postoperative delirium using the 3D-CAM will be assessed. On postoperative day 2, QoR-40 and pain assessments will be repeated, and postoperative opioid consumption, post-anesthesia care unit stay, complications, and patient satisfaction will be recorded. Postoperative questionnaires and cognitive assessments will be performed by an investigator blinded to the anesthesia technique.
Eligibility
Inclusion Criteria:
- Age 65 years or older
- ASA physical status I-III
- Scheduled to undergo elective or emergency hip fracture surgery under general anesthesia
- Provision of informed consent by the patient and/or legal representative
Exclusion Criteria:
- Refusal to participate in the study
- ASA physical status IV-V
- Severe pre-existing neurological or psychiatric disorders, including advanced dementia or severe cognitive impairment preventing communication
- Known hypersensitivity or allergy to propofol or sevoflurane
- History of chronic heavy opioid or sedative substance use
- Inability to communicate in Turkish or to understand and complete the QoR-40 questionnaire
