Department of Cardio-Thoracic Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China.
Department of Anesthesiology, West China Hospital of Sichuan University, Sichuan, Chengdu, 610041, China.
Int J Surg. 2022 Sep;105:106854. doi: 10.1016/j.ijsu.2022.106854. Epub 2022 Aug 27.
Randomized trials have shown conflicting results regarding differences in outcomes according to anesthesia type on the prevalence of postoperative delirium (POD) or postoperative cognitive dysfunction (POCD) in hip surgery patients. The aim of this Meta analysis is to compare the effect of general and regional anesthesia in older patients undergoing hip fracture surgery.
A literature search for meta-analysis was performed using Pubmed, The Cochrane Library, Embase and Web of Science citation index for randomized controlled trials (RCTs) to compare the regional anesthesia (RA) to general anesthesia (GA) for postoperative outcomes in elderly undergoing hip fracture surgery till June 2022. The primary outcomes were the incidence of POD or POCD at 24 h, 3 days and 7 days postoperatively. The secondary outcomes were 30 days mortality rate and other adverse events. The risk of bias was assessed using the Cochrane methodology.
Eight studies including 3555 elderly patients over 65 years old showed that there was no significant difference in the prevalence of POD or POCD between RA and GA at 24 h [OR 0.73; 95% coincidence interval (CI) 0.19, 2.71, I = 53%; n = 452; P = 0.63], at 3 days [OR 1.03; 95% CI 0.79, 1.35, I = 0%; n = 1362; P = 0.82], at 7 days [OR 0.79; 95% CI 0.41, 1.52, I = 51%; n = 1336; P = 0.47], respectively. No significant differences were observed in the incidence of other adverse events.
No significant difference was found in the incidence of cognitive dysfunction after either general or regional anesthesia in elderly patients. Our finding of similar outcomes at 24 h, 3 days and 7 days postoperatively with either technique suggests that anesthesia choices for hip-fracture surgery may be based on the individual characteristics of each patient rather than on anticipated differences in clinical outcomes.
随机试验对于髋关节手术患者术后谵妄（POD）或术后认知功能障碍（POCD）发生率的麻醉类型差异得出了相互矛盾的结果。本 Meta 分析的目的是比较全身麻醉和区域麻醉对老年髋部骨折手术患者的影响。
使用 Pubmed、The Cochrane Library、Embase 和 Web of Science 引文索引进行文献检索，以荟萃分析的形式对 2022 年 6 月前的随机对照试验（RCT）进行检索，比较区域麻醉（RA）与全身麻醉（GA）对老年髋部骨折手术患者术后结局的影响。主要结局为术后 24 小时、3 天和 7 天 POD 或 POCD 的发生率。次要结局为 30 天死亡率和其他不良事件。使用 Cochrane 方法学评估偏倚风险。
八项研究共纳入 3555 名 65 岁以上的老年人，结果显示，RA 与 GA 在术后 24 小时[OR 0.73；95%置信区间（CI）0.19，2.71，I=53%；n=452；P=0.63]、术后 3 天[OR 1.03；95% CI 0.79，1.35，I=0%；n=1362；P=0.82]、术后 7 天[OR 0.79；95% CI 0.41，1.52，I=51%；n=1336；P=0.47]时 POD 或 POCD 的发生率无显著差异。其他不良事件的发生率也无显著差异。
全身麻醉和区域麻醉后老年患者认知功能障碍的发生率无显著差异。我们发现两种技术在术后 24 小时、3 天和 7 天的结果相似，这表明髋部骨折手术的麻醉选择可以基于每个患者的个体特征，而不是基于预期的临床结果差异。
