Reg Anesth Pain Med. 2018 Jan;43(1):25-35. doi: 10.1097/AAP.0000000000000687.
Amputations of the lower extremity remain a common procedure in a high-risk population. Perioperative morbidity and mortality reach as high as 14.1% in below-knee amputations. We aimed to determine whether regional, or neuraxial, anesthesia, when compared with general anesthesia (GA), would be associated with reduced perioperative morbidity and mortality.
We queried the American College of Surgeons National Surgical Quality Improvement Program data set. The study population was divided into 2 groups: patients undergoing regional anesthesia (RA) and those undergoing GA. The primary end point for our study was 30-day mortality. The secondary end points were return to the operating room, surgical site infections, pulmonary complications, acute kidney injury, urinary tract infection, cardiac arrest, myocardial infarction, perioperative transfusions, thromboembolisms, sepsis, composite measure of postoperative complications, and days from operation to discharge.
Twelve thousand seven hundred twenty-three patients were identified. Older patients, white patients, patients with a higher body mass index, patients without dyspnea, patients with independent functional status, smokers, patients with sepsis, and patients with bleeding disorders were associated with receiving GA. Hispanic patients, patients with chronic obstructive pulmonary disease, and patients with congestive heart failure were associated with receiving RA. Our study did not reveal a 30-day mortality difference between RA and GA. Regional anesthesia was associated with a significantly decreased need for perioperative blood transfusions (11.8% vs 16.5%, P < 0.001) and a decrease in the composite measure of postoperative complications (25.7% vs 29.1%, P < 0.04).
Regional anesthesia does not offer a mortality advantage over GA, but RA may reduce the need for perioperative blood transfusions.
下肢截肢仍然是高危人群中的常见手术。膝下截肢的围手术期发病率和死亡率高达 14.1%。我们旨在确定与全身麻醉（GA）相比，区域或神经轴麻醉是否会降低围手术期发病率和死亡率。
我们查询了美国外科医师学院国家手术质量改进计划数据集。研究人群分为 2 组：接受区域麻醉（RA）的患者和接受 GA 的患者。我们研究的主要终点是 30 天死亡率。次要终点是返回手术室、手术部位感染、肺部并发症、急性肾损伤、尿路感染、心脏骤停、心肌梗死、围手术期输血、血栓栓塞、败血症、术后并发症综合指标以及从手术到出院的天数。
确定了 12723 名患者。年龄较大的患者、白人患者、体重指数较高的患者、无呼吸困难的患者、功能状态独立的患者、吸烟者、患有败血症的患者和患有出血性疾病的患者更有可能接受 GA。西班牙裔患者、慢性阻塞性肺疾病患者和充血性心力衰竭患者更有可能接受 RA。我们的研究并未发现 RA 和 GA 之间 30 天死亡率存在差异。与 GA 相比，RA 与围手术期输血需求显著减少（11.8%对 16.5%，P<0.001）和术后并发症综合指标降低（25.7%对 29.1%，P<0.04）相关。
与 GA 相比，区域麻醉并没有带来死亡率优势，但 RA 可能会减少围手术期输血的需求。
