Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Department of Surgery, Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
J Surg Oncol. 2023 Jun;127(7):1092-1102. doi: 10.1002/jso.27226. Epub 2023 Mar 13.
Anesthesia methods in oncologic breast surgery have evolved with less invasive practices. The aims of this study were primarily to examine trends in anesthesia type used during lumpectomy.
We analyzed lumpectomy procedures from 2005 to 2019 using the NSQIP database. Upon defining the nadir in general anesthesia (GA) and peak in monitored anesthesia care (MAC) use as 2007, we compared patient characteristics and complications in the 2007 versus 2019 GA and MAC cohorts. Multivariable logistic regression was used to examine associations with receipt of GA.
Of 253 545 lumpectomy patients, 191 773 (75.6%) received GA and 61 772 (24.4%) received MAC. From 2005 to 2019, GA rates increased from 66.7% to 82.5%, while MAC rates decreased from 33.3% to 17.5%. More GA patients were obese and American Society of Anesthesiologists class 3. Over time, age and body mass index (BMI) increased in both GA and MAC cohorts. Odds of receiving GA increased over time, and predictors included concurrent axillary lymph node dissection (p < 0.0001) or sentinel lymph node biopsy (p < 0.0001).
We demonstrate increasing use of GA over time for lumpectomy, which may be related to aging lumpectomy patient population with higher BMIs. We also find a strong association between use of GA and concurrent lymph node procedures.
在肿瘤乳腺手术中，麻醉方法已经随着微创技术的发展而演变。本研究的主要目的是研究在乳腺肿瘤切除术期间使用的麻醉类型的趋势。
我们使用 NSQIP 数据库分析了 2005 年至 2019 年的乳腺肿瘤切除术。在将全身麻醉（GA）的最低点和监测麻醉护理（MAC）的最高点定义为 2007 年之后，我们比较了 2007 年和 2019 年 GA 和 MAC 组的患者特征和并发症。多变量逻辑回归用于检查与 GA 接受的关联。
在 253545 例乳腺肿瘤切除术患者中，191773 例（75.6%）接受 GA，61772 例（24.4%）接受 MAC。从 2005 年到 2019 年，GA 率从 66.7%增加到 82.5%，而 MAC 率从 33.3%降低到 17.5%。更多的 GA 患者肥胖且美国麻醉医师协会（ASA）分级为 3 级。随着时间的推移，GA 和 MAC 组的年龄和体重指数（BMI）均增加。接受 GA 的几率随着时间的推移而增加，预测因素包括同时进行的腋窝淋巴结清扫术（p<0.0001）或前哨淋巴结活检术（p<0.0001）。
我们证明随着时间的推移，乳腺肿瘤切除术的 GA 使用越来越多，这可能与 BMI 较高的老龄化乳腺肿瘤切除术患者人群有关。我们还发现 GA 的使用与同期淋巴结手术之间存在很强的关联。
