Fukuda Taeko, Imai Shinobu, Shimoda Shunji, Maruo Kazushi, Nakadera Masaya, Horiguchi Hiromasa
Department of Anesthesiology, Faculty of Medicine, 13121University of Tsukuba, Tsukuba, Japan.
Kasumigaura Medical Center Hospital (Tsuchiura Clinical Education and Training Center), 13504National Hospital Organization, Tsuchiura, Japan.
J Orthop Surg (Hong Kong). 2022 Jan-Apr;30(1):10225536221078622. doi: 10.1177/10225536221078622.
Aspiration pneumonia is a critical issue. General anesthesia may suppress the airway's protective reflex. However, aspiration pneumonia is also observed in patients who undergo hip fracture surgery under spinal anesthesia. The aim of this study was to investigate the relationship between anesthesia methods and aspiration pneumonia as well as the predictive factors of aspiration pneumonia in elderly patients undergoing hip fracture surgery. The medical records of 19,809 patients aged ≥60 years who underwent hip fracture surgery under general or spinal anesthesia were reviewed. After propensity score matching, the anesthesia methods affecting the occurrences of aspiration pneumonia and other complications were investigated via logistic regression and instrumental variable analyses. Predictive factors of aspiration pneumonia were also investigated in all subjects using a multivariable logistic regression analysis. Among the 11,673 general anesthesia patients and 8136 spinal anesthesia patients, aspiration pneumonia occurred in 356 patients (1.8%). Post-propensity score matching the incidences of aspiration pneumonia with general and spinal anesthesia were 1.8% and 1.5%, respectively ( = 0.158); other pulmonary complications were 1.5% and 1.5%, respectively ( = 0.893); and the mortality rates were 1.4% and 1.2%, respectively ( = 0.219). The predictive factors of aspiration pneumonia were advanced age, male sex, lean body, cerebrovascular disease, dementia, and dependency for activities of daily living (eating). Spinal and general anesthesia showed similar incidences of aspiration pneumonia in elderly hip fracture surgery. Regardless of the anesthesia method, great care should be taken, especially in elderly patients with the identified predictive factors.
误吸性肺炎是一个关键问题。全身麻醉可能会抑制气道的保护性反射。然而，在接受脊髓麻醉下进行髋部骨折手术的患者中也观察到误吸性肺炎。本研究的目的是调查麻醉方法与误吸性肺炎之间的关系以及老年髋部骨折手术患者误吸性肺炎的预测因素。回顾了19809例年龄≥60岁在全身或脊髓麻醉下接受髋部骨折手术患者的病历。在倾向得分匹配后，通过逻辑回归和工具变量分析研究影响误吸性肺炎及其他并发症发生的麻醉方法。还使用多变量逻辑回归分析在所有受试者中研究误吸性肺炎的预测因素。在11673例全身麻醉患者和8136例脊髓麻醉患者中，356例（1.8%）发生了误吸性肺炎。倾向得分匹配后，全身麻醉和脊髓麻醉的误吸性肺炎发生率分别为1.8%和1.5%（P = 0.158）；其他肺部并发症发生率分别为1.5%和1.5%（P = 0.893）；死亡率分别为1.4%和1.2%（P = 0.219）。误吸性肺炎的预测因素为高龄、男性、消瘦、脑血管疾病、痴呆以及日常生活活动（进食）依赖。在老年髋部骨折手术中，脊髓麻醉和全身麻醉的误吸性肺炎发生率相似。无论采用何种麻醉方法，都应格外小心，尤其是对于具有已确定预测因素的老年患者。
