Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; North Texas VA Healthcare System, Dallas, TX, USA.
Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
Am J Surg. 2021 Sep;222(3):619-624. doi: 10.1016/j.amjsurg.2021.01.026. Epub 2021 Jan 22.
Frailty predisposes patients to poor postoperative outcomes. We evaluated whether using local rather than general anesthesia for hernia repair could mitigate effects of frailty.
We used the Risk Analysis Index (RAI) to identify 8,038 frail patients in the 1998-2018 Veterans Affairs Surgical Quality Improvement Program database who underwent elective, open unilateral inguinal hernia repair under local or general anesthesia. Our outcome of interest was the incidence of postoperative complications.
In total, 5,188 (65%) patients received general anesthesia and 2,850 (35%) received local. Local anesthesia was associated with a 48% reduction in complications (OR 0.52, 95%CI 0.38-0.72). Among the frailest patients (RAI≥70), predicted probability of a postoperative complication ranged from 22 to 33% with general anesthesia, compared to 13-21% with local.
Local anesthesia was associated with a ∼50% reduction in postoperative complications in frail Veterans. Given the paucity of interventions for frail patients, there is an urgent need for a randomized trial comparing effects of anesthesia modality on postoperative complications in this vulnerable population.
衰弱使患者术后预后不良。我们评估了疝修补术采用局部麻醉而非全身麻醉是否可以减轻衰弱的影响。
我们使用风险分析指数（RAI）从 1998 年至 2018 年退伍军人事务部手术质量改进计划数据库中确定了 8038 例患有衰弱的患者，这些患者接受了择期、开放性单侧腹股沟疝修补术，采用局部或全身麻醉。我们感兴趣的结果是术后并发症的发生率。
共有 5188 例（65%）患者接受全身麻醉，2850 例（35%）接受局部麻醉。局部麻醉与并发症减少 48%相关（OR 0.52，95%CI 0.38-0.72）。在最虚弱的患者（RAI≥70）中，全身麻醉的术后并发症预测概率为 22-33%，而局部麻醉的预测概率为 13-21%。
局部麻醉与衰弱退伍军人术后并发症减少约 50%相关。鉴于针对衰弱患者的干预措施很少，迫切需要一项随机试验来比较麻醉方式对这一脆弱人群术后并发症的影响。
