Chu Chin-Chen, Weng Shih-Feng, Chen Kuan-Ting, Chien Chih-Chiang, Shieh Ja-Ping, Chen Jen-Yin, Wang Jhi-Joung
From the Department of Anesthesiology (C.-C. Chu, K.-T.C., J.-P.S., J.-Y.C., J.-J.W.), Department of Medical Research (S.-F.W., J.-J.W.), and Department of Nephrology (C.-C. Chien), Chi Mei Medical Center, Tainan, Taiwan; Department of Senior Service Management (J.-Y.C.), Department of Hospital and Health Care Administration (S.-F.W.), and Department of Recreation and Health-Care Management (C.-C. Chu), Chia-Nan University of Pharmacy and Science, Tainan, Taiwan; and Department of Medical Laboratory Science and Biotechnology, Chung Hwa University of Medical Technology, Tainan, Taiwan (C.-C. Chien).
Anesthesiology. 2015 Jul;123(1):136-47. doi: 10.1097/ALN.0000000000000695.
The effects of the mode of anesthesia on major adverse postoperative outcomes in geriatric patients are still inconclusive. The authors hypothesized that a neuraxial anesthetic (NA) rather than a general anesthetic (GA) would yield better in-hospital postoperative outcomes for geriatric patients undergoing hip surgery.
The authors used data from Taiwan's 1997-2011 in-patient claims database to evaluate the effect of anesthesia on in-hospital outcomes. The endpoints were mortality, stroke, transient ischemic stroke, myocardial infarction, respiratory failure, and renal failure. Of the 182,307 geriatric patients who had hip surgery, a GA was given to 53,425 (29.30%) and an NA to 128,882 (70.70%). To adjust for baseline differences and selection bias, patients were matched on propensity scores, which left 52,044 GA and 52,044 NA patients.
GA-group patients had a greater percentage and higher odds of adverse in-hospital outcomes than did NA-group patients: death (2.62 vs. 2.13%; odds ratio [OR], 1.24; 95% CI, 1.15 to 1.35; P < 0.001), stroke (1.61 vs. 1.38%; OR, 1.18, 95% CI, 1.07 to 1.31; P = 0.001), respiratory failure (1.67 vs. 0.63%; OR, 2.71; 95% CI, 2.38 to 3.01; P < 0.001), and intensive care unit admission (11.03 vs. 6.16%; OR, 1.95; 95% CI, 1.87 to 2.05; P < 0.001), analyzed using conditional logistic regression. Moreover, patients given a GA had longer hospital stays (10.77 ± 8.23 vs. 10.44 ± 6.67 days; 95% CI, 0.22 to 0.40; P < 0.001) and higher costs (New Taiwan Dollars [NT$] 86,606 ± NT$74,162 vs. NT$74,494 ± NT$45,264; 95% CI, 11,366 to 12,859; P < 0.001).
For geriatric patients undergoing hip surgery, NA was associated with fewer odds of adverse outcomes than GA.
麻醉方式对老年患者术后主要不良结局的影响仍无定论。作者推测，对于接受髋关节手术的老年患者，神经轴索麻醉（NA）相较于全身麻醉（GA）能产生更好的院内术后结局。
作者使用了台湾1997 - 2011年住院理赔数据库中的数据来评估麻醉对院内结局的影响。终点指标为死亡率、中风、短暂性脑缺血发作、心肌梗死、呼吸衰竭和肾衰竭。在182,307例接受髋关节手术的老年患者中，53,425例（29.30%）接受了GA，128,882例（70.70%）接受了NA。为调整基线差异和选择偏倚，对患者进行倾向评分匹配，最终留下52,044例GA患者和52,044例NA患者。
使用条件逻辑回归分析，GA组患者院内不良结局的百分比和几率高于NA组患者：死亡（2.62%对2.13%；优势比[OR]，1.24；95%置信区间[CI]，1.15至1.35；P < 0.001）、中风（1.61%对1.38%；OR，1.18，95% CI，1.07至1.31；P = 0.001）、呼吸衰竭（1.67%对0.63%；OR，2.71；95% CI，2.38至3.01；P < 0.001）以及重症监护病房入住率（11.03%对6.16%；OR，1.95；95% CI，1.87至2.05；P < 0.001）。此外，接受GA的患者住院时间更长（10.77 ± 8.23天对10.44 ± 6.67天；95% CI，0.22至0.40；P < 0.001）且费用更高（新台币[NT$]86,606 ± NT$74,162对NT$74,494 ± NT$45,264；95% CI，11,366至12,859；P < 0.001）。
对于接受髋关节手术的老年患者，NA相较于GA不良结局的几率更低。
