Department of Anesthesiology, Ube Industries Central Hospital, 750 Nishikiwa, Ube-city, Yamaguchi, 755-0151, Japan.
J Anesth. 2022 Dec;36(6):698-706. doi: 10.1007/s00540-022-03101-3. Epub 2022 Sep 1.
Postoperative delirium incidences are increasing in older adults. A Cochrane Review found no significant difference in the incidence of postoperative delirium between total intravenous anesthesia (TIVA) and inhalational anesthesia (IA). This study evaluated the differences in postoperative delirium and morbidity between patients who underwent either TIVA or IA.
A nationwide Japanese inpatient database was used to retrospectively compare differences in postoperative delirium and composite morbidity between patients older than 65 years, who underwent general anesthesia (TIVA or IA). The primary outcome was postoperative delirium. The secondary outcomes were: morbidity incidence, length of hospital stay, and mortality. A 1:3 propensity score analysis of patients who underwent all surgical procedures was conducted according to covariates, to calculate odds ratios and their 95% confidence intervals (CIs). Sensitivity analyses were conducted using an instrumental variable analysis of the proportion of TIVA by hospital scale, stabilized inverse probability of treatment weighting analyses, limiting the definitions of postoperative delirium, and subgroup analysis.
Of 738,600 patients, 149,540 received TIVA and 589,060 received IA. After 1:3 propensity score matching, the adjusted odds ratios for postoperative delirium and composite morbidity were 0.93 (95% CI 0.91-0.95) and 0.94 (95% CI 0.90-0.97), respectively, for TIVA concerning IA. There were no differences in the length of the intensive care unit and hospital stay, or hospital mortality. The findings were consistent with the sensitivity analyses.
This study demonstrated that TIVA was related to a slightly decreased postoperative delirium and incidence of morbidity compared to IA.
老年人术后谵妄的发生率正在增加。Cochrane 综述发现，全凭静脉麻醉（TIVA）和吸入麻醉（IA）之间术后谵妄的发生率没有显著差异。本研究评估了接受 TIVA 或 IA 的患者术后谵妄和复合发病率的差异。
使用全国性的日本住院患者数据库，回顾性比较了 65 岁以上接受全身麻醉（TIVA 或 IA）的患者术后谵妄和复合发病率的差异。主要结局是术后谵妄。次要结局是发病率、住院时间和死亡率。根据协变量对所有手术患者进行了 1:3 倾向评分分析，以计算比值比及其 95%置信区间（CI）。使用医院规模 TIVA 比例的工具变量分析、稳定逆概率处理加权分析、限制术后谵妄的定义和亚组分析进行了敏感性分析。
在 738600 名患者中，149540 名患者接受了 TIVA，589060 名患者接受了 IA。在 1:3 倾向评分匹配后，TIVA 与 IA 相比，术后谵妄和复合发病率的调整比值比分别为 0.93（95%CI 0.91-0.95）和 0.94（95%CI 0.90-0.97）。重症监护病房和住院时间或医院死亡率没有差异。敏感性分析结果一致。
与 IA 相比，TIVA 与术后谵妄和发病率略有降低相关。
