Kim Joseph, Curran Brian P, Du Austin L, Gabriel Rodney A
Anesthesiology, Kaiser Permanente, Fontana, USA.
Anesthesiology, University of California San Diego, La Jolla, USA.
Cureus. 2022 Apr 26;14(4):e24496. doi: 10.7759/cureus.24496. eCollection 2022 Apr.
Background and objective A high rate of preoperative anemia has been observed in patients undergoing knee and hip arthroplasty. The type of anesthesia that patients receive may play a role in preventing or minimizing adverse outcomes in these patients. In this study, we aimed to examine the complication rates in patients with severe anemia undergoing this surgery. In addition, we explore whether neuraxial anesthesia is associated with better outcomes compared to general anesthesia. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) registry was used to extract data related to patients who underwent total hip or knee arthroplasty from 2014 to 2016. Only those patients with a hematocrit level <30% were included, and they were classified into two groups based on primary anesthesia type received: neuraxial versus general anesthesia. The primary outcome of interest was postoperative transfusion. Secondary outcomes included 30-day hospital readmission and postoperative complications. Multivariable logistic regression was used to model primary anesthesia type to outcomes while controlling for various confounders. The odds ratio (OR) and their 95% confidence intervals (CI) were reported. Results There were 1,723 patients with severe anemia included in our analysis, of which 41.2% received neuraxial anesthesia. Among patients that received neuraxial versus general anesthesia, 170 (31.08%) and 486 (41.33%), respectively, received a postoperative blood transfusion (p<0.001). On multivariable regression analysis, neuraxial anesthesia was associated with 40% decreased odds of postoperative transfusion (OR: 0.63, 95% CI: 0.51-0.79, p<0.0001), but it was not associated with any other outcomes. Conclusion Neuraxial anesthesia can reduce the risk of postoperative transfusion in severely anemic patients undergoing total joint arthroplasty (TJA), ultimately leading to reduced discomfort, hospital expenditure, and adverse outcomes.
在接受膝关节和髋关节置换术的患者中，术前贫血发生率较高。患者接受的麻醉类型可能在预防或最小化这些患者的不良结局中发挥作用。在本研究中，我们旨在检查重度贫血患者接受该手术的并发症发生率。此外，我们探讨与全身麻醉相比，椎管内麻醉是否与更好的结局相关。方法：使用美国外科医师学会国家外科质量改进计划（ACS NSQIP）登记处的数据，提取2014年至2016年接受全髋关节或膝关节置换术患者的相关数据。仅纳入那些血细胞比容水平<30%的患者，并根据接受的主要麻醉类型将他们分为两组：椎管内麻醉与全身麻醉。感兴趣的主要结局是术后输血。次要结局包括30天内再次入院和术后并发症。在控制各种混杂因素的同时，使用多变量逻辑回归对主要麻醉类型与结局进行建模。报告比值比（OR）及其95%置信区间（CI）。结果：我们的分析纳入了1723例重度贫血患者，其中41.2%接受了椎管内麻醉。在接受椎管内麻醉与全身麻醉的患者中，分别有170例（31.08%）和486例（41.33%）接受了术后输血（p<0.001）。多变量回归分析显示，椎管内麻醉与术后输血几率降低40%相关（OR：0.63，95%CI：0.51-0.79，p<0.0001），但与任何其他结局均无关联。结论：椎管内麻醉可降低重度贫血患者接受全关节置换术（TJA）后输血的风险，最终减少不适、医院支出和不良结局。
