Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
Reg Anesth Pain Med. 2019 Sep;44(9):847-853. doi: 10.1136/rapm-2019-100417. Epub 2019 Jul 11.
Spinal anesthesia (SA) has physiological benefits over general anesthesia (GA), but there is insufficient evidence regarding a mortality benefit. We performed a retrospective propensity score-matched cohort study to evaluate the impact of anesthetic technique on mortality and major morbidity in patients undergoing hip fracture surgery.
Clinical, laboratory and outcome data were extracted from electronic databases for patients who underwent hip fracture surgery over a 13-year period at the University Health Network in Toronto, Ontario, Canada. The anesthetic technique was documented (SA or GA), and the primary outcome was 90-day mortality. Secondary outcomes included mortality at 30 and 60 days, hospital length of stay, pulmonary embolism (PE), major blood loss and major acute cardiac events. A propensity-score matched-pair analysis was performed following a non-parsimonious logistic regression model.
Of the 2591 patients identified, 883 patients in the SA group were matched to patients in the GA group in a 1:1 ratio. There was a weak association between SA and lower 90-day mortality (risk ratio (RR) 0.74, 95% CI 0.52 to 0.96, 99% CI 0.48 to 1.00, p=0.037). SA was also associated with a lower incidence of both PE (1.3% vs 0.5%, p<0.001) and major blood loss (7.7% vs 4.8%, p<0.001) and a shorter hospital length of stay by about 2 days (median 11.9 vs 10 days, p=0.024). There was no difference in major cardiac events or mortality at 30 and 60 days.
This propensity-score matched-pairs cohort study suggests that SA is weakly associated with a lower 90-day mortality following hip fracture surgery. SA was also associated with improved morbidity evidenced by a lower rate of PE and major blood loss and a shorter hospital length of stay. Given the retrospective nature of the study, these results are not proof of causality.
椎管内麻醉（SA）在生理上优于全身麻醉（GA），但关于其死亡率获益的证据不足。我们进行了一项回顾性倾向评分匹配队列研究，以评估麻醉技术对接受髋部骨折手术患者的死亡率和主要发病率的影响。
从加拿大安大略省多伦多大学健康网络的电子数据库中提取了 13 年期间接受髋部骨折手术的患者的临床、实验室和结果数据。记录了麻醉技术（SA 或 GA），主要结果是 90 天死亡率。次要结果包括 30 天和 60 天死亡率、住院时间、肺栓塞（PE）、大量失血和主要急性心脏事件。使用非简约逻辑回归模型进行了倾向评分匹配对分析。
在 2591 名患者中，883 名患者在 SA 组中与 GA 组进行了 1:1 配对。SA 与较低的 90 天死亡率呈弱相关（风险比（RR）0.74，95%置信区间 0.52 至 0.96，99%置信区间 0.48 至 1.00，p=0.037）。SA 还与较低的 PE 发生率（1.3%比 0.5%，p<0.001）和大量失血发生率（7.7%比 4.8%，p<0.001）相关，并使住院时间缩短约 2 天（中位数 11.9 天比 10 天，p=0.024）。30 天和 60 天的主要心脏事件或死亡率无差异。
这项倾向评分匹配对队列研究表明，SA 与髋部骨折手术后 90 天死亡率降低呈弱相关。SA 还与较低的发病率相关，表现为 PE 和大量失血发生率较低，住院时间较短。鉴于研究的回顾性性质，这些结果不能证明因果关系。
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