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Background and Aims The REGAIN and RAGA trials (published in October and December 2021) demonstrated equivalence between general and neuraxial anesthesia among surgical hip fracture cases for outcomes including postoperative delirium or a composite of death or an inability to walk at 60 days post-surgery. It is unclear to what extent these trials may have influenced decision-making on choice of anesthetic.Methods This retrospective study used January 2016-December 2023 US Premier Healthcare claims data on surgical hip fractures. An interrupted time series approach with segmented regression compared the pre-REGAIN/RAGA (January 2016-December 2021) to the post-REGAIN/RAGA period in monthly rates of only neuraxial anesthesia (as a proportion of surgical hip fracture performed under only general anesthesia plus those performed under only neuraxial anesthesia). Trends within each period were estimated, and their differential, including 95% confidence intervals (CIs). Additionally, we assessed trends in subgroups based on hospital teaching status and hospital hip fracture volume (dichotomized using the 75th percentile).Results The pre-REGAIN/RAGA period included n=23,587 (6.3%) and n=351,405 (93.7%) cases performed under neuraxial and general anesthesia, respectively. This was n=5,748 (5.2%) and n=105,588 (94.8%) for the post-REGAIN/RAGA period. Post-REGAIN/RAGA publication there was a significant decrease in use of neuraxial anesthesia in surgical hip fractures (difference in trend -0.089 CI -0.152;-0.026 p=0.0068); figure 1. This change was not different between teaching and non-teaching hospitals (p=0.9247), while was significantly different between high-volume and non-high-volume hospitals (p=0.0225).Abstract OP23 Figure 1Monthly percentage neuraxial anesthesia use among surgical hip fracture cases in the pre- and post-REGAIN/RAGA period; table provides data on pre-/-post trends including the differentialConclusions The post-REGAIN/RAGA period coincided with significant reductions in neuraxial anesthesia use among surgical hip fracture cases. Change was irrespective of hospital teaching status but did differ based on surgical volume. These findings are particularly prudent given the ongoing discussion on optimal anesthesia type, especially regarding the selection of relevant outcomes and (known) lower odds of various perioperative complications associated with neuraxial anesthesia.