From the Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD (Harris, and Thakkar), the California Health Sciences University, Clovis, CA (Valenzuela), the Department of Anesthesiology, Johns Hopkins Hospital, Baltimore, MD (Andrade), the Department of Orthopaedic Surgery, The George Washington University, Washington, DC (Agarwal, and Gu), the Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA (Golladay), and the Orthopaedics Research Collaborative (ORC) (Harris, Gu, Golladay, and Thakkar).
J Am Acad Orthop Surg. 2024 Jan 1;32(1):33-40. doi: 10.5435/JAAOS-D-23-00192. Epub 2023 Aug 21.
Spinal anesthesia (SA) allows total joint arthroplasty to be done while minimizing opioids and systemic anesthetic agents compared with general anesthesia (GA). SA has been associated with shortened postoperative recovery; however, the relationship between SA, major postoperative complications, and pneumonia (PNA) remains unclear.
Patients in a large, national database who underwent total hip arthroplasty or total knee arthroplasty from 2010 to 2020 were identified. 1:1 propensity score matching was used to create matched groups of patients who underwent SA and GA. The groups were matched by age, sex, chronic obstructive pulmonary disease, smoking status, Charlson Comorbidity Index, and American Society of Anesthesiology (ASA) classification. 1:1 matching was also done among the ASA classifications as a subanalysis.
Overall, equally matched groups of 217,267 patients who underwent SA versus GA were identified. 850 patients (0.39%) developed postoperative PNA after GA versus 544 patients (0.25%) after SA ( P < 0.001). The risk of major complications was 6,922 (3.2%) in the GA group and 5,401 (2.5%) in the SA group ( P < 0.001). Similarly, the risk of unplanned postoperative reintubation was higher (0.18% versus 0.10%, P < 0.001) and mortality was higher (0.14% versus 0.09%, P < 0.001) in the GA group than in the SA group. In ASA 1 to 3 patients, the risk of PNA was 0.08% to 0.21% higher with GA than with SA. In ASA 4 patients, the risk of PNA was 0.42% higher in SA than in GA (1.92% versus 1.5%, P < 0.001) and the mortality rate was nearly doubled in GA than in SA (1.46% versus 0.77%, P = 0.017).
Overall, GA was associated with a small but markedly higher rate of major complications, mortality, and PNA than SA in patients undergoing total joint arthroplasty when matching for differences in comorbidities. ASA 4 patients experienced the greatest increase in absolute risk of mortality with GA versus SA.
与全身麻醉（GA）相比，椎管内麻醉（SA）可在减少阿片类药物和全身麻醉药物的同时完成全关节置换术。SA 已与术后恢复时间缩短相关；然而，SA 与主要术后并发症和肺炎（PNA）之间的关系尚不清楚。
从 2010 年至 2020 年，在一个大型国家数据库中确定了接受全髋关节置换术或全膝关节置换术的患者。使用 1:1 倾向评分匹配创建接受 SA 和 GA 的患者匹配组。通过年龄、性别、慢性阻塞性肺疾病、吸烟状况、Charlson 合并症指数和美国麻醉医师协会（ASA）分类对两组进行匹配。ASA 分类的 1:1 匹配也作为亚分析进行。
总体而言，确定了接受 SA 与 GA 的 217267 例患者的匹配组。GA 后有 850 例（0.39%）患者发生术后 PNA，而 SA 后有 544 例（0.25%）患者发生 PNA（P < 0.001）。GA 组的主要并发症风险为 6922 例（3.2%），SA 组为 5401 例（2.5%）（P < 0.001）。同样，GA 组的计划性术后再插管风险更高（0.18%比 0.10%，P < 0.001），死亡率更高（0.14%比 0.09%，P < 0.001）。在 ASA 1 至 3 级患者中，GA 组的 PNA 风险比 SA 组高 0.08%至 0.21%。在 ASA 4 级患者中，SA 组的 PNA 风险比 GA 组高 0.42%（1.92%比 1.5%，P < 0.001），GA 组的死亡率几乎是 SA 组的两倍（1.46%比 0.77%，P = 0.017）。
总体而言，在对共病进行匹配后，与 SA 相比，GA 与全关节置换术患者的主要并发症、死亡率和 PNA 发生率略高，但差异显著。ASA 4 级患者接受 GA 治疗时，死亡率的绝对风险增加最大。
