Center for Surgical Science, Zealand University Hospital, Roskilde, Denmark.
Clinical Pharmacology and Pharmacy, Odense University Hospital, Odense, Denmark.
Br J Anaesth. 2022 Sep;129(3):416-426. doi: 10.1016/j.bja.2022.03.019. Epub 2022 Apr 27.
Postoperative complications are common after colorectal surgery, and possibly related to the type of anaesthesia. We aimed to determine associations between the type of anaesthesia and complications after colorectal cancer surgery using Danish registries.
Patients undergoing colorectal cancer surgery (2004-18) were identified in the Danish Colorectal Cancer Group Database. The cohort was enriched with the Danish Anaesthesia Database and Danish National Prescription Registry data linked by Danish Central Person Registration number. Patients were classified according to type of general anaesthesia: inhalation or TIVA. Confounders were adjusted by propensity score matching. The primary outcome was complications within 30 days postoperatively. Secondarily, we assessed specific medical and surgical complications.
We identified 22 179 individuals undergoing colorectal cancer surgery with accompanying anaesthesia data. Propensity score matching yielded 8722 individuals per group. After propensity score matching, postoperative complications were seen in 1933 (22.2%) patients undergoing inhalation anaesthesia and in 2199 (25.2%) undergoing TIVA (odds ratio [OR]=0.84; 95% confidence interval [CI], 0.79-0.91). Although no difference was observed for medical complications, 1369 (15.7%) undergoing inhalation anaesthesia had surgical complications compared with 1708 (19.6%) undergoing TIVA (OR=0.76; 95% CI, 0.71-0.83). Rates of wound dehiscence, anastomotic leak, ileus, wound abscess, intra-abdominal abscess, and sepsis were statistically significantly lower in the inhalation anaesthesia group.
In this propensity score-matched registry study, use of inhalation anaesthesia was associated with fewer postoperative complications after colorectal cancer surgery than use of TIVA. Inhalation anaesthesia was associated with fewer complications related to wound healing and surgical infections.
结直肠手术后常见术后并发症，可能与麻醉类型有关。本研究旨在通过丹麦登记处确定结直肠癌手术后麻醉类型与并发症之间的关系。
在丹麦结直肠癌组数据库中确定接受结直肠癌手术（2004-18 年）的患者。该队列通过丹麦麻醉数据库和丹麦国家处方登记处的数据进行了丰富，这些数据通过丹麦中央人员登记号进行了链接。根据全身麻醉类型将患者分为吸入或 TIVA 组。通过倾向评分匹配调整混杂因素。主要结局为术后 30 天内的并发症。其次，评估了特定的医疗和手术并发症。
我们确定了 22179 例接受结直肠癌手术并伴有麻醉数据的患者。通过倾向评分匹配，每组各有 8722 例患者。在倾向评分匹配后，接受吸入麻醉的患者中有 1933 例（22.2%）发生术后并发症，接受 TIVA 的患者中有 2199 例（25.2%）发生术后并发症（比值比[OR]=0.84；95%置信区间[CI]，0.79-0.91）。尽管在医疗并发症方面没有差异，但接受吸入麻醉的患者中有 1369 例（15.7%）发生手术并发症，而接受 TIVA 的患者中有 1708 例（19.6%）发生手术并发症（OR=0.76；95%CI，0.71-0.83）。在吸入麻醉组中，切口裂开、吻合口漏、肠梗阻、切口脓肿、腹腔脓肿和脓毒症的发生率明显较低。
在这项倾向评分匹配的登记研究中，与 TIVA 相比，结直肠癌手术后使用吸入麻醉与较少的术后并发症相关。吸入麻醉与与伤口愈合和手术感染相关的并发症较少有关。
