The First College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China.
Institute of Orthopaedics and Traumatology of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China.
J Knee Surg. 2021 Aug;34(10):1120-1125. doi: 10.1055/s-0040-1701486. Epub 2020 Feb 19.
This study evaluated whether the type of anesthesia independently related to risk of blood transfusion events in patients undergoing total knee arthroplasty (TKA) after adjusting for other covariates. This was a secondary analysis of a retrospective cohort study of patients undergoing primary unilateral TKA in Singapore. The independent variable was the type of anesthesia and the dependent variable was blood transfusion events. A multivariable logistic regression analysis was performed adjusting for variables that might affect the choice of anesthesia or blood transfusion events. Additional analyses examined this association by the subgroup analysis by using stratified multivariate logistic regression models. Of all 2,366 patients undergoing primary unilateral TKA, 120 (5.1%) developed blood transfusion events. Sixty-four (4.1%) of 1,560 patients with regional anesthesia (RA) developed blood transfusion events, compared with 56 (6.9%) of 806 patients with general anesthesia (GA; ( = 0.003). After adjusting for age, sex, preoperative hemoglobin, and other variables, patients who received RA had a decreased risk of blood transfusion events compared with those receiving GA (odds ratio [OR]: 0.53, 95% confidence interval [CI]: 0.35-0.81). This risk further decreased in male (OR: 0.20, 95% CI: 0.07-0.59) and participants whose operation time ≥ 90 minutes (OR: 0.39, 95% CI: 0.19-0.78). Our results indicated that patients receiving primary unilateral TKA who were managed with RA had a significantly decreased risk of blood transfusion events compared with those with GA, especially in male and participants whose operation time ≥ 90 minutes.
本研究评估了在调整其他协变量后，接受全膝关节置换术（TKA）的患者的麻醉类型是否与输血事件的风险独立相关。这是对新加坡接受单侧初次 TKA 的患者进行的回顾性队列研究的二次分析。自变量是麻醉类型，因变量是输血事件。进行了多变量逻辑回归分析，调整了可能影响麻醉选择或输血事件的变量。进一步的分析通过使用分层多变量逻辑回归模型进行亚组分析来检查这种关联。在所有接受单侧初次 TKA 的 2366 名患者中，有 120 名（5.1%）发生了输血事件。在接受区域麻醉（RA）的 1560 名患者中，有 64 名（4.1%）发生了输血事件，而在接受全身麻醉（GA）的 806 名患者中，有 56 名（6.9%）发生了输血事件（ = 0.003）。在调整年龄、性别、术前血红蛋白和其他变量后，与接受 GA 的患者相比，接受 RA 的患者输血事件的风险降低（比值比[OR]：0.53，95%置信区间[CI]：0.35-0.81）。这种风险在男性（OR：0.20，95%CI：0.07-0.59）和手术时间≥90 分钟的参与者（OR：0.39，95%CI：0.19-0.78）中进一步降低。我们的结果表明，与接受 GA 的患者相比，接受单侧初次 TKA 的患者接受 RA 管理时输血事件的风险显著降低，尤其是在男性和手术时间≥90 分钟的患者中。
