Department of Anesthesiology (M.A.H., M.S.A., A.B.A., D.J.K., and H.A.K.), Department of Orthopedic Surgery (J.C.C.), and Department of Surgery (B.L.H.), Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110. E-mail address for M.A. Helwani:
J Bone Joint Surg Am. 2015 Feb 4;97(3):186-93. doi: 10.2106/JBJS.N.00612.
Many orthopaedic surgical procedures can be performed with either regional or general anesthesia. We hypothesized that total hip arthroplasty with regional anesthesia is associated with less postoperative morbidity and mortality than total hip arthroplasty with general anesthesia.
This retrospective propensity-matched cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database included patients who had undergone total hip arthroplasty from 2007 through 2011. After matching, logistic regression was used to determine the association between the type of anesthesia and deep surgical site infections, hospital length of stay, thirty-day mortality, and cardiovascular and pulmonary complications.
Of 12,929 surgical procedures, 5103 (39.5%) were performed with regional anesthesia. The adjusted odds for deep surgical site infections were significantly lower in the regional anesthesia group than in the general anesthesia group (odds ratio [OR] = 0.38; 95% confidence interval [CI] = 0.20 to 0.72; p < 0.01). The hospital length of stay (geometric mean) was decreased by 5% (95% CI = 3% to 7%; p < 0.001) with regional anesthesia, which translates to 0.17 day for each total hip arthroplasty. Regional anesthesia was also associated with a 27% decrease in the odds of prolonged hospitalization (OR = 0.73; 95% CI = 0.68 to 0.89; p < 0.001). The mortality rate was not significantly lower with regional anesthesia (OR = 0.78; 95% CI = 0.43 to 1.42; p > 0.05). The adjusted odds for cardiovascular complications (OR = 0.61; 95% CI = 0.44 to 0.85) and respiratory complications (OR = 0.51; 95% CI = 0.33 to 0.81) were all lower in the regional anesthesia group.
Compared with general anesthesia, regional anesthesia for total hip arthroplasty was associated with a reduction in deep surgical site infection rates, hospital length of stay, and rates of postoperative cardiovascular and pulmonary complications. These findings could have an important medical and economic impact on health-care practice.
许多骨科手术可以在局部麻醉或全身麻醉下进行。我们假设，与全身麻醉下的全髋关节置换术相比，局部麻醉下的全髋关节置换术与术后发病率和死亡率较低相关。
本回顾性倾向匹配队列研究利用美国外科医师学院国家手术质量改进计划（ACS NSQIP）数据库，纳入了 2007 年至 2011 年间接受全髋关节置换术的患者。匹配后，使用逻辑回归确定麻醉类型与深部手术部位感染、住院时间、30 天死亡率以及心血管和肺部并发症之间的关联。
在 12929 例手术中，5103 例（39.5%）采用局部麻醉。与全身麻醉组相比，局部麻醉组深部手术部位感染的调整优势比显著降低（比值比[OR] = 0.38；95%置信区间[CI] = 0.20 至 0.72；p < 0.01）。采用局部麻醉，住院时间（几何平均值）缩短 5%（95%CI = 3%至 7%；p < 0.001），每例全髋关节置换术缩短 0.17 天。局部麻醉还与住院时间延长的几率降低 27%相关（OR = 0.73；95%CI = 0.68 至 0.89；p < 0.001）。采用局部麻醉，死亡率并未显著降低（OR = 0.78；95%CI = 0.43 至 1.42；p > 0.05）。心血管并发症（OR = 0.61；95%CI = 0.44 至 0.85）和呼吸系统并发症（OR = 0.51；95%CI = 0.33 至 0.81）的调整优势比在局部麻醉组均较低。
与全身麻醉相比，全髋关节置换术的局部麻醉与降低深部手术部位感染率、住院时间以及术后心血管和肺部并发症发生率相关。这些发现可能对医疗保健实践具有重要的医学和经济影响。
