Vu M M, Galiano R D, Souza J M, Du Qin C, Kim J Y S
Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 675 North St. Clair Street Galter Suite 19-250, Chicago, IL, 60611, USA.
Hernia. 2016 Aug;20(4):517-25. doi: 10.1007/s10029-015-1455-5. Epub 2016 Feb 9.
Monitored anesthesia care with intravenous sedation (MAC/IV), recently proposed as a good choice for hernia repair, has faster recovery and better patient satisfaction than general anesthesia; however the possibility of oversedation and respiratory distress is a widespread concern. There is a paucity of the literature examining umbilical hernia repairs (UHR) and optimal anesthesia choice, despite its importance in determining clinical outcomes.
A retrospective analysis of anesthesia type in UHR was performed in the National Surgical Quality Improvement Program 2005-2013 database. General anesthesia and MAC/IV groups were propensity-score-matched (PSM) to reduce treatment selection bias. Surgical complications, medical complications, and post-operative hospital stays exceeding 1 day were the primary outcomes of interest. Pre-operative characteristics and post-operative outcomes were compared between the two anesthesia groups using univariate and multivariate statistics.
PSM removed all observed differences between the two groups (p > 0.05 for all tracked pre-operative characteristics). MAC/IV cases required fewer post-operative hospital stays exceeding 1 day (3.5 vs 6.3 %, p < 0.001). Univariate analysis showed that overall complication rate did not differ (1.7 vs 1.8 %, p = 0.569), however MAC/IV cases resulted in fewer incidences of septic shock (<0.1 vs 0.1 %, p = 0.016). After multivariate logistic regression, MAC/IV was revealed to yield significantly lower chances of overall medical complications (OR = 0.654, p = 0.046).
UHR under MAC/IV causes fewer medical complications and reduces post-operative hospital stays compared to general anesthesia. The implications for surgeons and patients are broad, including improved surgical safety, cost-effective care, and patient satisfaction.
静脉镇静下的监测麻醉护理（MAC/IV），最近被提议作为疝气修补术的一个良好选择，与全身麻醉相比，其恢复更快且患者满意度更高；然而，过度镇静和呼吸窘迫的可能性是一个广泛关注的问题。尽管脐疝修补术（UHR）在决定临床结果方面很重要，但研究脐疝修补术及最佳麻醉选择的文献却很少。
在国家外科质量改进计划2005 - 2013数据库中对脐疝修补术的麻醉类型进行回顾性分析。全身麻醉组和MAC/IV组进行倾向评分匹配（PSM）以减少治疗选择偏倚。手术并发症、医疗并发症以及术后住院时间超过1天是主要关注的结果。使用单变量和多变量统计方法比较两个麻醉组之间的术前特征和术后结果。
PSM消除了两组之间所有观察到的差异（所有追踪的术前特征p>0.05）。MAC/IV病例术后住院时间超过1天的情况较少（3.5%对6.3%，p<0.001）。单变量分析显示总体并发症发生率无差异（1.7%对1.8%，p = 0.569），然而MAC/IV病例导致感染性休克的发生率较低（<0.1%对0.1%，p = 0.016）。经过多变量逻辑回归分析，发现MAC/IV导致总体医疗并发症的几率显著降低（OR = 0.654，p = 0.046）。
与全身麻醉相比，MAC/IV下的脐疝修补术导致的医疗并发症更少，并减少了术后住院时间。这对外科医生和患者具有广泛的意义，包括提高手术安全性、具有成本效益的护理以及患者满意度。
