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Whether the use of spinal versus general anesthesia for hip fracture surgery affects outcomes is uncertain. In a multicenter randomized trial (REGAIN) comparing the two techniques in 1600 patients who underwent hip fracture surgery, both groups had similar mortality, ability to walk at 60 days postoperatively, postoperative delirium, and time to discharge. The spinal anesthesia group had lower rates of in-hospital mortality, acute kidney injury, and critical care admission, but statistical analysis was not performed for these outcomes. For patients in whom either type of anesthesia would be appropriate, we suggest spinal anesthesia to reduce the need for mechanical ventilation and achieve a more rapid return to baseline mental status.