From the Department of Anesthesiology and Critical Care, Perelman School of Medicine and Center for Health Outcomes and Policy Research, University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania.
Anesth Analg. 2013 Oct;117(4):1010-1016. doi: 10.1213/ANE.0b013e3182a1bf1c. Epub 2013 Sep 10.
Surgical stress has been shown to result in immune disturbance. Neuraxial anesthesia (NA) has long been hypothesized to blunt undesired surgical insults and thus limit immune compromise and improve surgical outcomes. We hypothesized that NA would decrease postoperative infectious complications compared with general anesthesia (GA) among knee arthroplasty patients.
We studied the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2010. There were 16,555 patients included in our final cohort, with 9167 patients receiving GA and 7388 patients receiving spinal or epidural anesthesia.. Outcomes of interest included infection-related 30-day postoperative complications, including surgical site-related infections, pneumonia, urinary tract infection, sepsis, septic shock, and a composite end point of any systemic infection. Multivariable logistic regression was performed to test for effect of anesthesia type while adjusting for the influence of preexisting comorbidities.
The overall mortality was 0.24% and 0.15% among NA and GA subjects, respectively (P = 0.214). NA subjects had fewer unadjusted incidences of pneumonia (P = 0.035) and composite systemic infection (P = 0.006). After risk adjustment for preexisting comorbidities, NA was associated with lower odds of pneumonia (odds ratio = 0.51 [95% confidence interval, 0.29-0.90]) and lower odds of composite systemic infection (odds ratio = 0.77 [95% confidence interval, 0.64-0.92]).
Our study suggested that NA was associated with lower adjusted odds of both pneumonia and a composite outcome of any systemic infectious complication within 30 days of surgery compared with GA.
手术应激已被证明会导致免疫紊乱。神经轴麻醉（NA）长期以来一直被假设为可以减轻不必要的手术损伤，从而限制免疫抑制并改善手术结果。我们假设 NA 会降低膝关节置换术患者的术后感染并发症发生率，与全身麻醉（GA）相比。
我们研究了 2005 年至 2010 年美国外科医师学会国家手术质量改进计划数据库。最终队列包括 16555 例患者，其中 9167 例接受 GA，7388 例接受脊髓或硬膜外麻醉。感兴趣的结果包括与感染相关的 30 天术后并发症，包括手术部位相关感染、肺炎、尿路感染、败血症、感染性休克和任何全身性感染的复合终点。进行多变量逻辑回归以检验麻醉类型的影响，同时调整预先存在的合并症的影响。
NA 和 GA 组的总体死亡率分别为 0.24%和 0.15%（P = 0.214）。NA 组未调整的肺炎发生率（P = 0.035）和复合全身性感染发生率（P = 0.006）较低。在对预先存在的合并症进行风险调整后，NA 与肺炎（比值比= 0.51[95%置信区间，0.29-0.90]）和复合全身性感染（比值比= 0.77[95%置信区间，0.64-0.92]）的可能性降低相关。
与 GA 相比，我们的研究表明，NA 与术后 30 天内肺炎和任何全身性感染并发症的复合结局的调整后可能性降低相关。
