Fukuda Taeko, Imai Shinobu, Nakadera Masaya, Wagatsuma Yukiko, Horiguchi Hiromasa
1 University of Tsukuba, Tsukuba, Ibaraki, Japan.
2 Faculty of Medicine, Department of Anesthesiology, Tsuchiura Center for Medical Education and Training (National Hospital Organization, Kasumigaura Medical Center), Tsuchiura, Ibaraki Prefecture, Japan.
J Orthop Surg (Hong Kong). 2018 Jan-Apr;26(1):2309499017754106. doi: 10.1177/2309499017754106.
Maintaining independence after hip fracture repair is important for geriatric patients and general welfare. We investigated the effects of anesthetic methods on postoperative activities of daily living (ADLs) following hip fracture surgery in elderly patients.
The medical records of 12,342 patients aged ≥65 years who underwent typical surgeries for hip fracture using either general anesthesia or spinal anesthesia were reviewed. To adjust for baseline differences and minimize selection bias for the chosen method of anesthesia, patients were matched by propensity scores. Factors affecting the deterioration in ADLs during hospital stay were also investigated in all subjects using a multivariate logistic regression analysis. Eating, grooming, toileting, bathing, and walking were selected as the ADL parameters, as they are considered important for an independent life.
Of the 12,342 patients, 6918 (56.1%) received general anesthesia and 5424 (43.9%) received spinal anesthesia. After the propensity score matching, the anesthesia types were not associated with ADL scores except toileting at discharge. Results from the multivariate logistic regression analysis showed that the types of anesthesia were not associated with deterioration in ADL scores. Advanced age, male sex, high Charlson Comorbidity Index scores, psychiatric disease, no administration of nonsteroidal anti-inflammatory drugs, and short length of hospital stay were associated with deterioration in ADL scores.
The anesthesia types were not associated with ADL dependency except toileting at discharge. Spinal anesthesia adversely affected toilet use at hospital discharge. However, anesthesia types were not factors that affected deterioration in ADL during hospital stay in elderly patients who underwent hip fracture surgery.
髋部骨折修复术后保持独立能力对老年患者及总体健康状况很重要。我们研究了麻醉方法对老年患者髋部骨折手术后日常生活活动（ADL）的影响。
回顾了12342例年龄≥65岁接受全身麻醉或脊髓麻醉进行典型髋部骨折手术患者的病历。为了调整基线差异并尽量减少所选麻醉方法的选择偏倚，通过倾向得分对患者进行匹配。还使用多因素逻辑回归分析在所有受试者中研究了影响住院期间ADL恶化的因素。进食、洗漱、如厕、洗澡和行走被选为ADL参数，因为它们被认为对独立生活很重要。
在12342例患者中，6918例（56.1%）接受全身麻醉，5424例（43.9%）接受脊髓麻醉。倾向得分匹配后，除出院时如厕外，麻醉类型与ADL评分无关。多因素逻辑回归分析结果显示，麻醉类型与ADL评分恶化无关。高龄、男性、高查尔森合并症指数评分、精神疾病、未使用非甾体抗炎药以及住院时间短与ADL评分恶化有关。
除出院时如厕外，麻醉类型与ADL依赖无关。脊髓麻醉对出院时的如厕有不利影响。然而，麻醉类型并非影响接受髋部骨折手术老年患者住院期间ADL恶化的因素。
