Department of Vascular and Endovascular Surgery, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.
Department of Vascular and Endovascular Surgery, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.
J Vasc Surg. 2021 Feb;73(2):700-710. doi: 10.1016/j.jvs.2020.08.112. Epub 2020 Sep 1.
To conduct a meta-analytic review of studies investigating the effect of the anesthesia modality on perioperative mortality in endovascular repair of ruptured abdominal aortic aneurysms (REVAR).
The present meta-analysis was performed in accordance with the PRISMA guidelines. Multiple electronic databases were comprehensively searched from database inception to January 2020. Eligible studies included cohort studies that reported the 30-day/in-hospital mortality rate or the multivariate adjusted odds ratio (OR) or hazard ratio of the mortality risk for patients who underwent emergency REVAR under locoregional anesthesia (LA) vs general anesthesia (GA). A random effects model was used to estimate the ORs by pooling the related data from individual studies.
A total of eight studies were included in this analysis. The first meta-analysis of seven studies that reported the 30-day/in-hospital mortality with a total of 3116 patients (867 in the LA group and 2249 in the GA group) revealed that LA was associated with a lower 30-day/in-hospital mortality than GA (16.4% vs 25.4%; unadjusted OR, 0.47; 95% confidence interval [CI], 0.32-0.68). The second meta-analysis of three of these seven studies (including 586 patients in the LA group and 1945 in the GA group) that reported the perioperative variables revealed comparable baseline characteristics but a lower 30-day/in-hospital mortality in the LA group (unadjusted OR, 0.55; 95% CI, 0.42-0.71). The third meta-analysis of the adjusted ORs or hazard ratios that were reported from four studies (including 501 patients in the LA group and 1136 in the GA group) showed a similar trend (adjusted OR,0.37; 95% CI, 0.19-0.75).
REVAR under LA is associated with a lower 30-day/in-hospital mortality than REVAR under GA. However, because the included studies may have had some observation bias, further randomized controlled trials are warranted to validate the present results.
对研究血管内修复破裂腹主动脉瘤（REVAR）中麻醉方式对围手术期死亡率影响的研究进行荟萃分析。
本荟萃分析按照 PRISMA 指南进行。从数据库建立之初到 2020 年 1 月，全面检索多个电子数据库。纳入的研究包括报告接受局部区域麻醉（LA）与全身麻醉（GA）下急诊 REVAR 患者 30 天/住院死亡率或多变量校正后死亡率风险比（OR）或风险比的队列研究。使用随机效应模型汇总来自各个研究的相关数据来估计 OR。
共有 8 项研究纳入本分析。对报告共 3116 例患者（LA 组 867 例，GA 组 2249 例）30 天/住院死亡率的 7 项研究的首次荟萃分析显示，LA 与 GA 相比，30 天/住院死亡率较低（16.4% vs. 25.4%；未校正 OR，0.47；95%置信区间 [CI]，0.32-0.68）。对其中 7 项研究的第二次荟萃分析（LA 组 586 例，GA 组 1945 例）报告围手术期变量，结果显示两组基线特征相似，但 LA 组 30 天/住院死亡率较低（未校正 OR，0.55；95%CI，0.42-0.71）。对报告 4 项研究的校正 OR 或风险比的第三次荟萃分析（LA 组 501 例，GA 组 1136 例）显示出相似趋势（校正 OR，0.37；95%CI，0.19-0.75）。
LA 下的 REVAR 与 GA 下的 REVAR 相比，30 天/住院死亡率较低。然而，由于纳入的研究可能存在一些观察偏倚，需要进一步的随机对照试验来验证本研究结果。
