Department of Anesthesiology, University of California, San Diego, San Diego, California.
Department of Anesthesiology, University of California, San Diego, San Diego, California; Department of Biomedical Informatics, University of California, San Diego, San Diego, California; Outcomes Research Consortium, Cleveland, Ohio.
J Arthroplasty. 2017 Dec;32(12):3632-3636. doi: 10.1016/j.arth.2017.06.028. Epub 2017 Jun 23.
There is sparse evidence on the benefit of neuraxial (NA) vs general anesthesia (GA) as the primary anesthetic in postoperative outcomes following bilateral total knee arthroplasty. We sought to elucidate differences in outcomes in this surgical population using a national database.
We used data from the National Surgical Quality Improvement Program from 2007 to 2013 and compared rates of various postoperative outcomes in propensity-matched cohorts (NA vs GA).
After exclusion, there were 1957 patients included in the final analysis, of which 26% received NA as the primary anesthetic. Propensity-matched cohorts were generated to ensure no differences in various comorbidities (including bleeding disorders or inadequate cessation of anticoagulation therapy), case duration, and patient demographics between both cohorts. Among the matched cohorts, there were no differences in preoperative platelet count, hematocrit, or international normalized ratio. NA was associated with decreased blood transfusion requirement and decreased total number of units of blood products transfused (P < .0001 for both outcomes). However, there were no differences in other outcomes, including hospital length of stay, pulmonary embolism, deep vein thrombosis, or urinary tract infections.
Our study demonstrates that in matched cohorts, NA is associated with decreased blood transfusion requirements in patients undergoing bilateral total knee arthroplasty when compared to GA as the primary anesthetic.
关于在双侧全膝关节置换术后，神经轴（NA）与全身麻醉（GA）作为主要麻醉方法的获益，相关证据有限。我们试图利用国家数据库阐明该手术人群的结果差异。
我们使用了 2007 年至 2013 年国家手术质量改进计划的数据，并比较了在倾向匹配队列中（NA 与 GA）各种术后结果的发生率。
排除后，最终分析包括 1957 例患者，其中 26%接受了 NA 作为主要麻醉方法。生成了倾向匹配队列，以确保两个队列在各种合并症（包括出血性疾病或抗凝治疗不充分）、手术持续时间和患者人口统计学方面没有差异。在匹配队列中，术前血小板计数、血细胞比容或国际标准化比值没有差异。NA 与减少输血需求和减少输血量（两种结果均 P <.0001）相关。然而，其他结果（包括住院时间、肺栓塞、深静脉血栓形成或尿路感染）没有差异。
我们的研究表明，在匹配队列中，与 GA 作为主要麻醉方法相比，NA 与双侧全膝关节置换术后患者的输血需求减少相关。
