From the Department of Anesthesiology, Hospital for Special Surgery, New York, New York (S.G.M., T.D., and O.S.); Department of Public Health, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, New York (R.R., J.P., and M.M.); Stony Brook University, Stony Brook, New York (P.G.); and Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California (E.R.M.).
Anesthesiology. 2014 Mar;120(3):551-63. doi: 10.1097/ALN.0000000000000120.
Much controversy remains on the role of anesthesia technique and peripheral nerve blocks (PNBs) in inpatient falls (IFs) after orthopedic procedures. The aim of the study is to characterize cases of IFs, identify risk factors, and study the role of PNB and anesthesia technique in IF risk in total knee arthroplasty patients.
The authors selected total knee arthroplasty patients from the national Premier Perspective database (Premier Inc., Charlotte, NC; 2006-2010; n = 191,570, >400 acute care hospitals). The primary outcome was IF. Patient- and healthcare system-related characteristics, anesthesia technique, and presence of PNB were determined for IF and non-IF patients. Independent risk factors for IFs were determined by using conventional and multilevel logistic regression.
Overall, IF incidence was 1.6% (n = 3,042). Distribution of anesthesia technique was 10.9% neuraxial, 12.9% combined neuraxial/general, and 76.2% general anesthesia. PNB was used in 12.1%. Patients suffering IFs were older (average age, 68.9 vs. 66.3 yr), had higher comorbidity burden (average Deyo index, 0.77 vs. 0.66), and had more major complications, including 30-day mortality (0.8 vs. 0.1%; all P < 0.001). Use of neuraxial anesthesia (IF incidence, 1.3%; n = 280) had lower adjusted odds of IF compared with adjusted odds of IF with the use of general anesthesia alone (IF incidence, 1.6%; n = 2,393): odds ratio, 0.70 (95% CI, 0.56-0.87). PNB was not significantly associated with IF (odds ratio, 0.85 [CI, 0.71-1.03]).
This study identifies several risk factors for IF in total knee arthroplasty patients. Contrary to common concerns, no association was found between PNB and IF. Further studies should determine the role of anesthesia practices in the context of fall-prevention programs.
在骨科手术后住院患者跌倒（IFs）中，麻醉技术和外周神经阻滞（PNBs）的作用仍存在很大争议。本研究的目的是描述 IFs 病例，确定危险因素，并研究 PNB 和麻醉技术在全膝关节置换术患者 IF 风险中的作用。
作者从全国 Premier 透视数据库（Premier Inc.，北卡罗来纳州夏洛特；2006-2010 年；n=191570 名，超过 400 家急性护理医院）中选择全膝关节置换术患者。IF 和非 IF 患者的患者和医疗系统相关特征、麻醉技术和 PNB 存在情况均被确定。通过常规和多级逻辑回归确定 IFs 的独立危险因素。
总体而言，IF 的发生率为 1.6%（n=3042）。麻醉技术的分布为 10.9%为椎管内麻醉，12.9%为椎管内/全身联合麻醉，76.2%为全身麻醉。使用 PNB 的占 12.1%。发生 IF 的患者年龄较大（平均年龄 68.9 岁比 66.3 岁），合并症负担较重（平均 Deyo 指数 0.77 比 0.66），且发生更多的重大并发症，包括 30 天死亡率（0.8%比 0.1%；均 P<0.001）。与单独使用全身麻醉相比，使用椎管内麻醉（IF 发生率为 1.3%；n=280）的 IF 调整后比值比更低（IF 发生率为 1.6%；n=2393）：比值比为 0.70（95%CI，0.56-0.87）。PNB 与 IF 无显著相关性（比值比 0.85[CI，0.71-1.03]）。
本研究确定了全膝关节置换术患者 IF 的几个危险因素。与普遍关注的情况相反，PNB 与 IF 之间未发现关联。进一步的研究应确定麻醉实践在预防跌倒计划中的作用。
