神经轴索麻醉显著降低初次全髋关节置换术30天静脉血栓栓塞率及住院时间：一项分层倾向评分匹配队列分析
Neuraxial Anesthesia Significantly Reduces 30-Day Venous Thromboembolism Rate and Length of Hospital Stay in Primary Total Hip Arthroplasty: A Stratified Propensity Score-Matched Cohort Analysis.
作者信息
Baldawi Mohanad, Awad Mohamed E, McKelvey George, Pearl Adam D, Mostafa Gamal, Saleh Khaled J
机构信息
NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan; Department of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan.
NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan; Michigan State University College of Osteopathic Medicine, Detroit, Michigan; Wayne State University, School of Medicine, Detroit, Michigan.
出版信息
J Arthroplasty. 2023 Jan;38(1):108-116. doi: 10.1016/j.arth.2022.07.003. Epub 2022 Jul 14.
BACKGROUND
General anesthesia (GA) has been the commonly used protocol for total hip arthroplasty (THA); however, neuraxial anesthesia (NA) has been increasingly performed. Our purpose was to compare NA and GA for 30-day postoperative outcomes in United States veterans undergoing primary THA.
METHODS
A large veteran's database was utilized to identify patients undergoing primary THA between 1999 and 2019. A total of 6,244 patients had undergone THA and were included in our study. Of these, 44,780 (79.6%) had received GA, and 10,788 (19.2%) had received NA. Patients receiving NA or GA were compared for 30-day mortalities, cardiovascular, respiratory, and renal complications, and wound infections and hospital lengths of stay (LOS). Propensity score matching, multivariate regression analyses, and subgroup analyses by American Society of Anesthesiology classification were performed to control for selection bias and patient baseline characteristics.
RESULTS
Upon propensity-adjusted multivariate analyses, NA was associated with decreased risks for deep venous thrombosis (odds ratio [OR] = 0.63; 95% CI = 0.4-0.9; P = .02), any respiratory complication (OR = 0.63; 95% CI = 0.5-0.9; P = .003), unplanned reintubation (OR = 0.51; 95% CI = 0.3-0.9; P = .009), and prolonged LOS (OR = 0.78; 95% CI = 0.72-0.84; P < .001). Subgroup analyses by American Society of Anesthesiology classes showed NA decreased 30-day venous thromboembolism rate in low-risk (class I/II) patients and decreased respiratory complications in high-risk (class III/IV) patients.
CONCLUSION
Using a patient cohort obtained from a large national database, NA was associated with reduced risk of 30-day adverse events compared to GA in patients undergoing THA. Postoperative adverse events were decreased with NA administration with similar decreases observed across all patient preoperative risk levels. NA was also associated with a significant decrease in hospital LOS.
背景
全身麻醉（GA）一直是全髋关节置换术（THA）常用的麻醉方案；然而，神经轴索麻醉（NA）的应用越来越多。我们的目的是比较接受初次全髋关节置换术的美国退伍军人术后30天的结局，比较神经轴索麻醉（NA）和全身麻醉（GA）。
方法
利用一个大型退伍军人数据库识别1999年至2019年间接受初次全髋关节置换术的患者。共有6244例患者接受了全髋关节置换术并纳入我们的研究。其中，44780例（79.6%）接受了全身麻醉，10788例（19.2%）接受了神经轴索麻醉。比较接受神经轴索麻醉或全身麻醉患者的30天死亡率、心血管、呼吸和肾脏并发症、伤口感染及住院时间（LOS）。进行倾向评分匹配、多变量回归分析以及按美国麻醉医师协会分类进行亚组分析，以控制选择偏倚和患者基线特征。
结果
经过倾向调整的多变量分析显示，神经轴索麻醉与深静脉血栓形成风险降低相关（比值比[OR]=0.63；95%置信区间[CI]=0.4 - 0.9；P = 0.02）、任何呼吸并发症风险降低相关（OR = 0.63；95% CI = 0.5 - 0.9；P = 0.003）、意外再次插管风险降低相关（OR = 0.51；95% CI = 0.3 - 0.9；P = 0.009）以及住院时间延长风险降低相关（OR = 0.78；95% CI = 0.72 - 0.84；P < 0.001）。按美国麻醉医师协会分级进行的亚组分析显示，神经轴索麻醉降低了低风险（I/II级）患者的30天静脉血栓栓塞率，降低了高风险（III/IV级）患者的呼吸并发症发生率。
结论
在接受全髋关节置换术的患者中，使用从大型国家数据库获得的患者队列，与全身麻醉相比，神经轴索麻醉与30天不良事件风险降低相关。给予神经轴索麻醉可降低术后不良事件发生率，在所有患者术前风险水平中观察到类似程度的降低。神经轴索麻醉还与住院时间显著缩短相关。
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