脊柱麻醉与全身麻醉对全髋关节置换术后30天结局的影响：一项配对队列分析。

Effect of spinal versus general anesthesia on thirty-day outcomes following total hip arthroplasty: A matched-pair cohort analysis.

作者信息

Knio Ziyad O, Clancy Paul W, Zuo Zhiyi

机构信息

Department of Anesthesiology, University of Virginia Health, Charlottesville, VA, United States of America.

School of Medicine, University of Virginia, Charlottesville, VA, United States of America.

出版信息

J Clin Anesth. 2023 Aug;87:111083. doi: 10.1016/j.jclinane.2023.111083. Epub 2023 Feb 26.

DOI:10.1016/j.jclinane.2023.111083

PMID:36848778

Abstract

STUDY OBJECTIVE

It has not yet been established whether total hip arthroplasty complications are associated with anesthetic technique (spinal versus general). This study assessed the effect of spinal versus general anesthesia on health care resource utilization and secondary endpoints following total hip arthroplasty.

DESIGN

Propensity-matched cohort analysis.

SETTING

American College of Surgeons National Surgical Quality Improvement Program participating hospitals from 2015 to 2021.

PATIENTS

Patients undergoing elective total hip arthroplasty (n = 223,060).

INTERVENTIONS

None.

MEASUREMENTS

The a priori study duration was 2015 to 2018 (n = 109,830). The primary endpoint was 30-day unplanned resource utilization, namely readmission and reoperation. Secondary endpoints included 30-day wound complications, systemic complications, bleeding events, and mortality. The impact of anesthetic technique was investigated with univariate analyses, multivariable analyses, and survival analyses.

MAIN RESULTS

The 1:1 propensity-matched cohort included 96,880 total patients (48,440 in each anesthesia group) from 2015 to 2018. On univariate analysis, spinal anesthesia was associated with a lower incidence of unplanned resource utilization (3.1% [1486/48440] vs 3.7% [1770/48440]; odds ratio [OR], 0.83 [95% CI, 0.78 to 0.90]; P < .001), systemic complications (1.1% [520/48440] vs 1.5% [723/48440]; OR, 0.72 [95% CI, 0.64 to 0.80]; P < .001), and bleeding events requiring transfusion (2.3% [1120/48440] vs 4.9% [2390/48440]; OR, 0.46 [95% CI, 0.42 to 0.49]; P < .001). On multivariable analysis, spinal anesthesia remained an independent predictor of unplanned resource utilization (adjusted odds ratio [AOR], 0.84 [95% CI, 0.78 to 0.90]; c = 0.646), systemic complications (AOR, 0.72 [95% CI, 0.64 to 0.81]; c = 0.676), and bleeding events (AOR, 0.46 [95% CI, 0.42 to 0.49]; c = 0.686). Hospital length of stay was also shorter in the spinal anesthesia cohort (2.15 vs 2.24 days; mean difference, -0.09 [95% CI, -0.12 to -0.07]; P < .001). Similar findings were observed in the cohort from 2019 to 2021.

CONCLUSIONS

Total hip arthroplasty patients receiving spinal anesthesia experience favorable outcomes compared to propensity-matched general anesthesia patients.

摘要

研究目的

全髋关节置换术并发症是否与麻醉技术（脊髓麻醉与全身麻醉）相关尚未明确。本研究评估了脊髓麻醉与全身麻醉对全髋关节置换术后医疗资源利用及次要终点的影响。

设计

倾向评分匹配队列分析。

地点

2015年至2021年参与美国外科医师学会国家外科质量改进计划的医院。

患者

接受择期全髋关节置换术的患者（n = 223,060）。

干预措施

无。

测量指标

预先设定的研究时间段为2015年至2018年（n = 109,830）。主要终点为30天内非计划资源利用，即再入院和再次手术。次要终点包括30天伤口并发症、全身并发症、出血事件和死亡率。采用单因素分析、多因素分析和生存分析研究麻醉技术的影响。

主要结果

1:1倾向评分匹配队列包括2015年至2018年的96,880例患者（每个麻醉组48,440例）。单因素分析显示，脊髓麻醉与非计划资源利用发生率较低相关（3.1%[1486/48440]对3.7%[1770/48440]；比值比[OR]，0.83[95%CI，0.78至0.90]；P <.001）、全身并发症（1.1%[520/48440]对1.5%[723/48440]；OR，0.72[95%CI，0.64至0.80]；P <.001）以及需要输血的出血事件（2.3%[1120/48440]对4.9%[2390/48440]；OR，0.46[95%CI，0.42至0.49]；P <.001）。多因素分析显示，脊髓麻醉仍然是非计划资源利用（调整后比值比[AOR]，0.84[95%CI，0.78至0.90]；c = 0.646）、全身并发症（AOR，0.72[95%CI，0.64至0.81]；c = 0.676）和出血事件（AOR，0.46[95%CI，0.42至0.49]；c = 0.686）的独立预测因素。脊髓麻醉组的住院时间也较短（2.15天对2.24天；平均差值，-0.09[95%CI，-0.12至-0.07]；P <.001）。在2019年至2021年的队列中观察到类似结果。