Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, People's Republic of China.
College of Clinical Medicine, Shantou University, Shantou, Guangdong Province, People's Republic of China.
Clin Interv Aging. 2021 May 17;16:833-841. doi: 10.2147/CIA.S311188. eCollection 2021.
To compare the effects of peripheral nerve block (PNB) and spinal anesthesia (SA) on one-year mortality and walking ability of elderly hip fracture patients after hip arthroplasty.
Patients ≥65 years who underwent unilateral hip arthroplasty due to femoral neck fracture, using either PNB or SA from 2014 to 2019, were included. Demographic data, comorbidities, and results of preoperative screening were retrospectively collected. Propensity score matching (PSM) was performed in a ratio of 1:1 for PNB and SA groups. The primary outcomes were 30-day, 90-day, and one-year mortality. Secondary outcomes included walking ability in the first postoperative year, major complications, length of stay, and the cost of hospitalization. Survival analysis was performed using Kaplan-Meier method.
Three hundred and sixteen patients were included, of whom 200 received SA and 116 received PNB. Eighty-nine patients in each group were matched after PSM. Patients in the PNB group showed significantly lower risks of death in 30 days (2.2% vs 10.1%, P=0.029) and 90 days (3.4% vs 12.4%, P=0.026) after hip arthroplasty, when compared to the SA group. There was no significant difference in one-year mortality, walking ability, major complications, and length of stay. Higher hospitalization cost was found in the PNB group (53,828.21 CNY vs 59,278.83 CNY, P=0.024). One-year accumulated survival rate was higher in the PNB group without reaching a significant level.
PNB was related to lower 30- and 90-day mortality but higher hospitalization cost in elderly hip fracture patients after hip arthroplasty. However, the anesthesia types were not associated with one-year mortality, one-year walking ability, major complications, and length of stay.
比较外周神经阻滞（PNB）和脊柱麻醉（SA）对老年髋部骨折患者髋关节置换术后一年死亡率和行走能力的影响。
纳入 2014 年至 2019 年因股骨颈骨折行单侧髋关节置换术且使用 PNB 或 SA 的年龄≥65 岁患者。回顾性收集人口统计学数据、合并症和术前筛查结果。采用 1:1 比例的倾向评分匹配（PSM）对 PNB 和 SA 组进行匹配。主要结局为 30 天、90 天和 1 年死亡率。次要结局包括术后第一年的行走能力、主要并发症、住院时间和住院费用。采用 Kaplan-Meier 法进行生存分析。
共纳入 316 例患者，其中 200 例接受 SA，116 例接受 PNB。PSM 后每组各有 89 例患者匹配。与 SA 组相比，PNB 组患者髋关节置换术后 30 天（2.2%比 10.1%，P=0.029）和 90 天（3.4%比 12.4%，P=0.026）的死亡风险显著降低。两组患者的 1 年死亡率、行走能力、主要并发症和住院时间无显著差异。PNB 组的住院费用较高（53828.21 元比 59278.83 元，P=0.024）。PNB 组 1 年累积生存率较高，但无统计学意义。
PNB 与老年髋部骨折患者髋关节置换术后 30 天和 90 天的死亡率较低相关，但与 1 年死亡率、1 年行走能力、主要并发症和住院时间无关。
