区域麻醉是否比全身麻醉更能减少全髋关节和膝关节置换术后的并发症？来自英格兰、威尔士、北爱尔兰和马恩岛国家联合登记处的分析。
Does Regional Anesthesia Reduce Complications Following Total Hip and Knee Replacement Compared With General Anesthesia? An Analysis From the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man.
机构信息
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, United Kingdom; Musculoskeletal Research Unit, Department of Translational Health Sciences, University of Bristol, Bristol, United Kingdom.
Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom.
出版信息
J Arthroplasty. 2020 Jun;35(6):1521-1528.e5. doi: 10.1016/j.arth.2020.02.003. Epub 2020 Feb 8.
BACKGROUND
Regional anesthesia is increasingly used in enhanced recovery programs following total hip replacement (THR) and total knee replacement (TKR). However, debate remains about its potential benefit over general anesthesia given that complications following surgery are rare. We assessed the risk of complications in THR and TKR patients receiving regional anesthesia compared with general anesthesia using the world's largest joint replacement registry.
METHODS
We studied the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man linked to English hospital inpatient episodes for 779,491 patients undergoing THR and TKR. Patients received either regional anesthesia (n = 544,620, 70%) or general anesthesia (n = 234,871, 30%). Outcomes assessed at 90 days included length of stay, readmissions, and complications. Regression models were adjusted for patient and surgical factors to determine the effect of anesthesia on outcomes.
RESULTS
Length of stay was reduced with regional anesthesia compared with general anesthesia (THR = -0.49 days, 95% confidence interval [CI] = -0.51 to -0.47 days, P < .001; TKR = -0.47 days, CI = -0.49 to -0.45 days, P < .001). Regional anesthesia also had a reduced risk of readmission (THR odds ratio [OR] = 0.93, CI = 0.90-0.96; TKA OR = 0.91, CI = 0.89-0.93), any complication (THR OR = 0.88, CI = 0.85-0.91; TKA OR = 0.90, CI = 0.87-0.93), urinary tract infection (THR OR = 0.85, CI = 0.77-0.94; TKR OR = 0.87, CI = 0.79-0.96), and surgical site infection (THR OR = 0.87, CI = 0.80-0.95; TKR OR = 0.84, CI = 0.78-0.89). Anesthesia type did not affect the risk of revision surgery or mortality.
CONCLUSION
Regional anesthesia was associated with reduced length of stay, readmissions, and complications following THR and TKR when compared with general anesthesia. We recommend regional anesthesia should be considered the reference standard for patients undergoing THR and TKR.
背景
在全髋关节置换术（THR）和全膝关节置换术（TKR）后，区域麻醉越来越多地用于加速康复计划。然而，由于手术后并发症很少，关于其相对于全身麻醉的潜在益处仍存在争议。我们使用全球最大的关节置换登记处评估了接受区域麻醉与全身麻醉的 THR 和 TKR 患者的并发症风险。
方法
我们研究了英格兰、威尔士、北爱尔兰和马恩岛的国家联合登记处，该登记处与英格兰住院患者的 779491 例 THR 和 TKR 病例相关联。患者接受区域麻醉（n=544620，70%）或全身麻醉（n=234871，30%）。90 天评估的结果包括住院时间、再入院和并发症。回归模型调整了患者和手术因素，以确定麻醉对结果的影响。
结果
与全身麻醉相比，区域麻醉可缩短住院时间（THR=-0.49 天，95%置信区间[CI]：-0.51 至-0.47 天，P<.001；TKR=-0.47 天，CI：-0.49 至-0.45 天，P<.001）。区域麻醉也降低了再入院的风险（THR 比值比[OR]：0.93，CI：0.90-0.96；TKA OR：0.91，CI：0.89-0.93），任何并发症（THR OR：0.88，CI：0.85-0.91；TKA OR：0.90，CI：0.87-0.93），尿路感染（THR OR：0.85，CI：0.77-0.94；TKR OR：0.87，CI：0.79-0.96）和手术部位感染（THR OR：0.87，CI：0.80-0.95；TKR OR：0.84，CI：0.78-0.89）。麻醉类型并不影响翻修手术或死亡率的风险。
结论
与全身麻醉相比，区域麻醉可降低 THR 和 TKR 后的住院时间、再入院和并发症发生率。我们建议区域麻醉应作为接受 THR 和 TKR 患者的参考标准。
Zotero 插件