Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
J Vasc Surg. 2023 May;77(5):1542-1552.e9. doi: 10.1016/j.jvs.2022.10.005. Epub 2022 Oct 13.
Postoperative morbidity in patients undergoing lower extremity amputation (LEA) has remained high. Studies investigating the influence of the anesthetic modality on the postoperative outcomes have yielded conflicting results. The aim of our study was to assess the effects of regional anesthesia vs general anesthesia on postoperative complications for patients undergoing LEA.
We systematically searched PubMed, Embase, MEDLINE, Web of Science, and Google Scholar from 1990 to 2022 for studies investigating the effect of the anesthetic modality on the postoperative outcomes after LEA. Regional anesthesia (RA) included neuraxial anesthesia and peripheral nerve blocks. The outcomes included 30-day mortality, respiratory failure (unplanned postoperative intubation, failure to wean, mechanical ventilation >24 hours), surgical site infection, cardiac complications, urinary tract infection, renal failure, sepsis, venous thrombosis, pneumonia, and myocardial infarction.
Of the 25 studies identified, we included 10 retrospective observational studies with 81,736 patients, of whom 69,754 (85.3%) had received general anesthesia (GA) and 11,980 (14.7%) had received RA. In the GA group, 50,468 patients were men (63.8%), and in the RA group, 7813 patients were men (62.3%). The results of the meta-analyses revealed that GA was associated with a higher rate of respiratory failure (odds ratio, 1.38; 95% confidence interval, 1.06-1.80; P = .02) and sepsis (odds ratio, 1.21; 95% confidence interval, 1.11-1.33; P < .0001) compared with RA. No differences were found in postoperative 30-day mortality, surgical site infection, cardiac complications, urinary tract infection, renal failure, venous thrombosis, pneumonia, and myocardial infarction between the GA and RA groups.
The results of our meta-analysis have shown that GA could be associated with a higher rate of respiratory failure and sepsis compared with RA for LEA.
下肢截肢（LEA）患者的术后发病率仍然很高。研究调查麻醉方式对术后结果的影响得出的结果相互矛盾。我们的研究目的是评估区域麻醉与全身麻醉对接受 LEA 的患者术后并发症的影响。
我们系统地检索了 1990 年至 2022 年期间 PubMed、Embase、MEDLINE、Web of Science 和 Google Scholar 中关于麻醉方式对 LEA 术后结果影响的研究。区域麻醉（RA）包括椎管内麻醉和外周神经阻滞。结果包括 30 天死亡率、呼吸衰竭（术后计划外插管、无法脱机、机械通气>24 小时）、手术部位感染、心脏并发症、尿路感染、肾衰竭、败血症、静脉血栓形成、肺炎和心肌梗死。
在确定的 25 项研究中，我们纳入了 10 项回顾性观察性研究，共 81736 例患者，其中 69754 例（85.3%）接受全身麻醉（GA），11980 例（14.7%）接受 RA。在 GA 组中，50468 例患者为男性（63.8%），在 RA 组中，7813 例患者为男性（62.3%）。荟萃分析结果表明，与 RA 相比，GA 与呼吸衰竭（优势比，1.38；95%置信区间，1.06-1.80；P=0.02）和败血症（优势比，1.21；95%置信区间，1.11-1.33；P<0.0001）的发生率更高相关。GA 组与 RA 组在术后 30 天死亡率、手术部位感染、心脏并发症、尿路感染、肾衰竭、静脉血栓形成、肺炎和心肌梗死方面无差异。
我们的荟萃分析结果表明，与 RA 相比，GA 可能与 LEA 后呼吸衰竭和败血症的发生率更高相关。
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