Wahood Waseem, Yolcu Yagiz, Alvi Mohammed Ali, Goyal Anshit, Long Timothy R, Bydon Mohamad
Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
Clin Neurol Neurosurg. 2019 May;180:79-86. doi: 10.1016/j.clineuro.2019.03.021. Epub 2019 Mar 29.
Endotracheal/general anesthesia is one of the most commonly used anesthetic techniques when performing thoracic and lumbar surgeries. However, spinal and epidural (non-general) anesthesia have been increasingly employed for lumbar decompressions (LD) and lumbar fusion recently. The objective of this study was to investigate the outcomes of general and non-general anesthesia in patients undergoing posterior lumbar fusion (PLF) and LD using a national registry.
ACS-NSQIP database was queried to identify patients who underwent LD or PLF with general or non-general anesthesia between 2011-2015. Patient characteristics and postoperative variables were compared. Multivariable regression was used to identify predictors of thirty-day readmission, any complication and length of stay (LOS). Three-to-one propensity-score matching and conditional logistic regression were used to adjust for potential bias.
A total of 60,222 patients who underwent LD were identified; 59,876 (99.4%) received general anesthesia and 342 (0.6%) were given non-general anesthesia. On multivariable conditional regression, type of anesthesia was found to have no significant effect on any of the outcomes analyzed (Readmission: OR:0.90, p = 0.79; Any Complication:OR:0.75, p = 0.75; LOS:Coef.:0.18, p = 0.35). A total of 31,419 patients who underwent PLF were identified; 31,377(99.9%) were given general anesthesia and 42(0.1%) were given non-general anesthesia. Anesthesia type had no significant effect on any of the outcomes analyzed (Readmission: OR:0.78, p = 0.83;Any Complication: OR:0.50, p = 0.40; LOS: Coef.:0.17, p = 0.68).
Our analysis showed that non-general anesthesia had equivalent outcomes with respect to readmission, LOS and complications compared to general anesthesia in patients undergoing LD or PLF. While the choice of anesthesia type remains a matter of preference, our results show that non-general anesthesia may be practiced safely and is associated with equivalent outcomes.
气管内/全身麻醉是进行胸腰椎手术时最常用的麻醉技术之一。然而，脊髓麻醉和硬膜外（非全身）麻醉最近在腰椎减压术（LD）和腰椎融合术中的应用越来越多。本研究的目的是使用国家登记数据库调查接受后路腰椎融合术（PLF）和LD的患者中全身麻醉和非全身麻醉的效果。
查询美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库，以确定2011年至2015年间接受LD或PLF并采用全身或非全身麻醉的患者。比较患者特征和术后变量。采用多变量回归分析确定30天再入院、任何并发症和住院时间（LOS）的预测因素。采用3:1倾向评分匹配和条件逻辑回归分析来调整潜在偏倚。
共识别出60222例接受LD的患者；59876例（99.4%）接受全身麻醉，342例（0.6%）接受非全身麻醉。在多变量条件回归分析中，发现麻醉类型对所分析的任何结局均无显著影响（再入院：比值比[OR]：0.90，p = 0.79；任何并发症：OR：0.75，p = 0.75；LOS：系数：0.18，p = 0.35）。共识别出31419例接受PLF的患者；31377例（99.9%）接受全身麻醉，42例（0.1%）接受非全身麻醉。麻醉类型对所分析的任何结局均无显著影响（再入院：OR：0.78，p = 0.83；任何并发症：OR：0.50，p = 0.40；LOS：系数：0.17，p = 0.68）。
我们的分析表明，在接受LD或PLF的患者中，与全身麻醉相比，非全身麻醉在再入院、LOS和并发症方面的效果相当。虽然麻醉类型的选择仍然是个人偏好问题，但我们的结果表明，非全身麻醉可以安全实施，且效果相当。
