Park Yong Bok, Chae Won Seok, Park Sin Hyung, Yu Ji Soo, Lee Sun Geun, Yim Soo Jae
Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
Knee Surg Relat Res. 2017 Jun 1;29(2):96-103. doi: 10.5792/ksrr.16.009.
To compare the occurrences of perioperative complications of two anesthetic techniques (general anesthesia [GA] and spinal anesthesia [SA] in patients undergoing primary unilateral total knee arthroplasty (TKA).
Patients who underwent unilateral primary TKA due to osteoarthritis from January 2005 to January 2014 were retrospectively reviewed. They were divided into two groups: GA (n=490) and SA (n=746). The operation duration, length of perioperative stay in the operation room and occurrences of adverse events in postoperative 30 days (mean, 29.7±3.1 days) were compared. Before multivariate linear or logistic regression analysis, different baseline characteristics were adjusted in the statistical models.
There were significant intergroup differences in mean age (GA, 68.4±7.2 years; SA, 70.7±7.5 years; p<0.001) and mCCI (GA, 3±1.4; SA, 3.2±1.5; p<0.001). The GA group required longer preoperative room time (+9.4 minutes; p<0.001), postoperative room time (+12.7 minutes; p<0.001), and postoperative hospital stay (+2.5 days; p=0.001) and had more surgical site infections (5 [1%] vs. 0 [0%]; p=0.005) and blood transfusion (205 [41.8%] vs. 262 [35.1%]; p=0.01). No differences in operative duration and other adverse events were identified.
We should cautiously consider that GA may be associated with slightly increased preoperative and postoperative room times, postoperative hospital stay, transfusion and surgical site infection rates in primary unilateral TKA.
比较全身麻醉（GA）和脊髓麻醉（SA）这两种麻醉技术用于初次单侧全膝关节置换术（TKA）患者时围手术期并发症的发生率。
回顾性分析2005年1月至2014年1月因骨关节炎接受单侧初次TKA的患者。他们被分为两组：GA组（n = 490）和SA组（n = 746）。比较手术时间、围手术期在手术室的停留时间以及术后30天（平均29.7±3.1天）不良事件的发生率。在进行多变量线性或逻辑回归分析之前，在统计模型中对不同的基线特征进行了调整。
平均年龄（GA组，68.4±7.2岁；SA组，70.7±7.5岁；p<0.001）和改良 Charlson 合并症指数（GA组，3±1.4；SA组，3.2±1.5；p<0.001）存在显著组间差异。GA组术前在手术室时间更长（+9.4分钟；p<0.001）、术后在手术室时间更长（+12.7分钟；p<0.001）、术后住院时间更长（+2.5天；p = 0.001），且手术部位感染更多（5例[1%] vs. 0例[0%]；p = 0.005）以及输血更多（205例[4l.8%] vs. 262例[35.1%]；p = 0.01）。未发现手术时间和其他不良事件存在差异。
我们应谨慎考虑，在初次单侧TKA中，GA可能与术前和术后在手术室时间、术后住院时间、输血及手术部位感染率的轻微增加有关。
