Department of Anesthesiology, Vanderbilt University Medical Centre, 1211 21st Ave S, MAB 403, Nashville, TN 37211, USA
Department of Anesthesiology, Washington University Medical Centre, Campus Box 8054, 660 Euclid Ave, St. Louis MO 63110, USA.
Br J Anaesth. 2017 Jan;118(1):105-111. doi: 10.1093/bja/aew383.
The anaesthetic technique may influence clinical outcomes, but inherent confounding and small effect sizes makes this challenging to study. We hypothesized that regional anaesthesia (RA) is associated with higher survival and fewer postoperative organ dysfunctions when compared with general anaesthesia (GA).
We matched surgical procedures and type of anaesthesia using the US National Surgical Quality Improvement database, in which 264,421 received GA and 64,119 received RA. Procedures were matched according to Current Procedural Terminology (CPT) and ASA physical status classification. Our primary outcome was 30-day postoperative mortality and secondary outcomes were hospital length of stay, and postoperative organ system dysfunction. After matching, multiple regression analysis was used to examine associations between anaesthetic type and outcomes, adjusting for covariates.
After matching and adjusting for covariates, type of anaesthesia did not significantly impact 30-day mortality. RA was significantly associated with increased likelihood of early discharge (HR 1.09; P< 0.001), 47% lower odds of intraoperative complications, and 24% lower odds of respiratory complications. RA was also associated with 16% lower odds of developing deep vein thrombosis and 15% lower odds of developing any one postoperative complication (OR 0.85; P < 0.001). There was no evidence of an effect of anaesthesia technique on postoperative MI, stroke, renal complications, pulmonary embolism or peripheral nerve injury.
After adjusting for clinical and patient characteristic confounders, RA was associated with significantly lower odds of several postoperative complications, decreased hospital length of stay, but not mortality when compared with GA.
麻醉技术可能会影响临床结果，但由于内在的混杂因素和较小的效应大小，这使得研究变得具有挑战性。我们假设与全身麻醉（GA）相比，区域麻醉（RA）与更高的生存率和更少的术后器官功能障碍相关。
我们使用美国国家手术质量改进数据库，根据手术程序和麻醉类型进行匹配，其中 264421 例接受 GA，64119 例接受 RA。根据当前程序术语（CPT）和美国麻醉医师协会身体状况分类对程序进行匹配。我们的主要结果是术后 30 天的死亡率，次要结果是住院时间和术后器官系统功能障碍。在匹配后，使用多元回归分析检查麻醉类型与结果之间的关联，并调整协变量。
在匹配和调整协变量后，麻醉类型对 30 天死亡率没有显著影响。RA 与早期出院的可能性增加显著相关（HR 1.09；P<0.001），术中并发症的几率降低 47%，呼吸并发症的几率降低 24%。RA 还与深静脉血栓形成的几率降低 16%和任何一种术后并发症的几率降低 15%相关（OR 0.85；P<0.001）。没有证据表明麻醉技术对术后心肌梗死、中风、肾脏并发症、肺栓塞或周围神经损伤有影响。
在调整了临床和患者特征混杂因素后，与 GA 相比，RA 与几种术后并发症的几率显著降低、住院时间缩短相关，但与死亡率无关。
