Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Int Urol Nephrol. 2019 Sep;51(9):1481-1489. doi: 10.1007/s11255-019-02208-z. Epub 2019 Jun 20.
Neuroaxial (i.e., spinal, regional, epidural) anesthesia has been shown to be associated with reduced readmission rate, decreased hospital stay, and decreased overall complication rate in orthopedic and gynecologic surgery. Our aim was to identify differences in intra- and postoperative complications, length of stay and readmission rates in open nephrectomy patients managed with neuroaxial anesthesia.
Utilizing National Surgical Quality Inpatient Program (NSQIP) database, we identified patients who have undergone an open nephrectomy between 2014 and 2017. Patients were further subdivided based on anesthesia modality. We used the propensity score-matching (PSM) method to adjust for baseline differences among patients who received general anesthesia alone and those with additional neuroaxial anesthesia. Using step-wise multivariable logistic regression, we identified preoperative and intraoperative predictors associated with 30-day procedure-related readmission, complications, and postoperative length of stay.
Out of 3,633 patients identified, 2346 patients met our inclusion and exclusion criteria. There was no difference in baseline characteristics after propensity score matching between general and additional neuroaxial anesthesia. Postoperative outcomes including: procedure-related readmission, rate of reoperation, operative time, all complications were similar between the groups. Adjuvant neuroaxial anesthesia group did experience a prolonged postoperative hospital stay that was statistically significant as compared to patients with general anesthesia alone [5.3 (3.5) days vs 4.8 (2.9) days, p = 0.007]. Compared to GA alone after multivariable logistic regression, neuroaxial anesthesia was not statistically significant for readmission (p = 0.909), any complication (p = 0.505), but did showed increased odds ratio of prolonged postoperative stay [aOR 1.107, 95% CI 1.042-1.176, p = 0.001] after adjusting for multiple factors.
Using 2014-2017 NSQIP database, we were able to demonstrate no additional reduction in complication or readmission rate in patients with neuroaxial anesthesia as compared to general anesthesia alone. Furthermore, patients who did receive neuroaxial anesthesia experienced a longer postoperative course.
神经轴（即脊髓、区域、硬膜外）麻醉已被证明与减少骨科和妇科手术后的再入院率、缩短住院时间和降低整体并发症发生率相关。我们的目的是确定接受神经轴麻醉的开放性肾切除术患者在围手术期并发症、住院时间和再入院率方面的差异。
利用国家手术质量住院患者计划（NSQIP）数据库，我们确定了 2014 年至 2017 年间接受开放性肾切除术的患者。根据麻醉方式，患者进一步分为两组。我们使用倾向评分匹配（PSM）方法来调整仅接受全身麻醉和接受额外神经轴麻醉的患者之间的基线差异。使用逐步多变量逻辑回归，我们确定了与 30 天与手术相关的再入院、并发症和术后住院时间相关的术前和术中预测因素。
在确定的 3633 名患者中，有 2346 名患者符合我们的纳入和排除标准。在倾向评分匹配后，全身麻醉和额外神经轴麻醉之间的基线特征没有差异。术后结果包括：与手术相关的再入院率、再次手术率、手术时间、所有并发症在两组之间相似。与仅接受全身麻醉的患者相比，辅助神经轴麻醉组的术后住院时间延长，这具有统计学意义[5.3（3.5）天比 4.8（2.9）天，p=0.007]。与全身麻醉相比，多变量逻辑回归后，神经轴麻醉在再入院率（p=0.909）、任何并发症（p=0.505）方面无统计学意义，但在调整多个因素后，显示出延长术后住院时间的更高比值比[优势比 1.107，95%置信区间 1.042-1.176，p=0.001]。
使用 2014-2017 年 NSQIP 数据库，我们能够证明与单独全身麻醉相比，神经轴麻醉并没有进一步降低并发症或再入院率。此外，接受神经轴麻醉的患者经历了更长的术后过程。
