Department of Surgical Services, John D. Dingell VA Medical Center, Detroit, MI.
Department of Surgical Services, John D. Dingell VA Medical Center, Detroit, MI; Department of Anesthesiology, Detroit Medical Center/Wayne State University, Detroit, MI.
J Arthroplasty. 2020 Nov;35(11):3138-3144. doi: 10.1016/j.arth.2020.06.030. Epub 2020 Jun 17.
The aim of this study is to investigate which anesthetic technique is superior on 30-day outcomes after primary total knee arthroplasty (TKA) in United States veteran patients. To our knowledge, this is the first account from the Veterans Health Administration comparing the effects of different anesthesia modalities in patients undergoing TKA.
The Veterans Affairs Surgical Quality Improvement Program database was utilized to analyze patients undergoing primary TKA during the period of 2008-2015. Subjects were divided into 2 cohorts based on the method of surgical anesthesia used: general anesthesia or neuraxial anesthesia. Propensity score matching was utilized to avoid possible selection bias between the 2 cohorts when assessing patient demographics and comorbidities. The 2 groups were analyzed for 30-day postoperative complications, using multivariable logistic regression techniques to evaluate independent associations between anesthetic method and postoperative outcomes.
All Veterans Affairs patients undergoing primary TKA under general anesthesia (n = 32,363) and neuraxial anesthesia (n = 14,395) within the study period were included in this study. Following propensity score matching, multivariable analysis revealed significantly lower risks of cardiovascular (adjusted odds ratio [AOR] 0.74, 95% confidence interval [CI] 0.6-0.88, P < .001), respiratory (AOR 0.75, 95% CI 0.57-0.97, P = .03), and renal complications (AOR 0.62, 95% CI 0.4-0.9, P = .01) in patients receiving neuraxial anesthesia compared to those receiving general anesthesia. Neuraxial anesthesia was also associated with reduced hospital stay and lower odds of prolonged hospitalization (AOR 0.85, 95% CI 0.8-0.9, P < .001).
Veteran patients undergoing TKA under neuraxial anesthesia had reduced postoperative complications and decreased hospitalization stay compared to patients undergoing general anesthesia.
本研究旨在探讨在美国退伍军人患者中，哪种麻醉技术在初次全膝关节置换术（TKA）后 30 天的结果更优。据我们所知，这是退伍军人事务部首次比较 TKA 患者使用不同麻醉方式的效果。
利用退伍军人事务部手术质量改进计划数据库分析 2008 年至 2015 年期间接受初次 TKA 的患者。根据手术麻醉方法将患者分为两组：全身麻醉或椎管内麻醉。采用倾向评分匹配法，以避免两组在评估患者人口统计学特征和合并症时可能存在选择偏倚。采用多变量逻辑回归技术分析两组患者术后 30 天的并发症，以评估麻醉方法与术后结果之间的独立关联。
研究期间，所有接受全身麻醉（n=32363）和椎管内麻醉（n=14395）初次 TKA 的退伍军人事务部患者均纳入本研究。经过倾向评分匹配后，多变量分析显示，接受椎管内麻醉的患者心血管并发症（校正比值比[OR]0.74，95%置信区间[CI]0.6-0.88，P<0.001）、呼吸系统并发症（OR 0.75，95%CI0.57-0.97，P=0.03）和肾脏并发症（OR 0.62，95%CI0.4-0.9，P=0.01）的风险显著降低。与接受全身麻醉的患者相比，接受椎管内麻醉的患者住院时间缩短，住院时间延长的可能性降低（OR 0.85，95%CI0.8-0.9，P<0.001）。
与接受全身麻醉的患者相比，接受椎管内麻醉的 TKA 退伍军人患者术后并发症减少，住院时间缩短。
