Feng Yan, Sun Jia-Feng, Wei Hai-Chao, Cao Ying, Yao Lei, Du Bo-Xiang
The Affiliated Hospital 2 of Nantong University, Nantong City, Jiangsu Province, People's Republic of China.
Clin Interv Aging. 2024 Apr 16;19:613-626. doi: 10.2147/CIA.S448898. eCollection 2024.
This study aims to investigate how the type of anesthesia used during major orthopedic surgery may impact adverse short-term postoperative outcomes depending on frailty.
To conduct this investigation, we recruited individuals aged 65 years and older who underwent major orthopedic surgery between March 2022 and April 2023 at a single institution. We utilized the FRAIL scale to evaluate frailty. The primary focus was on occurrences of death or the inability to walk 60 days after the surgery. Secondary measures included death within 60 days; inability to walk without human assistance at 60 days; death or the inability to walk without human assistance at 30 days after surgery, the first time out of bed after surgery, postoperative blood transfusion, length of hospital stay, hospital costs, and the occurrence of surgical complications such as dislocation, periprosthetic fracture, infection, reoperation, wound complications/hematoma.
In a study of 387 old adult patients who had undergone major orthopedic surgery, 41.3% were found to be in a frail state. Among these patients, 262 had general anesthesia and 125 had neuraxial anesthesia. Multifactorial logistic regression analyses showed that anesthesia type was not linked to complications. Instead, frailty (OR 4.04, 95% CI 1.04 to 8.57, P< 0.001), age (OR 1.05, 95% CI 1.00-1.10, P= 0.017), and aCCI scores, age-adjusted Charlson Comorbidity Index, (OR 1.36, 95% CI 1.12 to 1.66, = 0.002) were identified as independent risk factors for death or new walking disorders in these patients 60 days after surgery. After adjusting for frailty, anesthesia methods was not associated with the development of death or new walking disorders in these patients (P > 0.05).
In different frail populations, neuraxial anesthesia is likely to be comparable to general anesthesia in terms of the incidence of short-term postoperative adverse outcomes.
本研究旨在调查大型骨科手术中使用的麻醉类型如何根据虚弱程度影响术后短期不良结局。
为进行此项调查，我们招募了2022年3月至2023年4月期间在一家机构接受大型骨科手术的65岁及以上个体。我们使用衰弱量表评估虚弱程度。主要关注术后60天内的死亡或无法行走情况。次要指标包括60天内死亡；60天内无人协助无法行走；术后30天内死亡或无人协助无法行走、术后首次下床、术后输血、住院时间、住院费用以及手术并发症（如脱位、假体周围骨折、感染、再次手术、伤口并发症/血肿）的发生情况。
在一项对387例接受大型骨科手术的老年患者的研究中，发现41.3%处于虚弱状态。在这些患者中，262例接受全身麻醉，125例接受神经轴索麻醉。多因素逻辑回归分析表明，麻醉类型与并发症无关。相反，虚弱（比值比4.04，95%置信区间1.04至8.57，P<0.001）、年龄（比值比1.05，95%置信区间1.00 - 1.10，P = 0.017）以及年龄校正的Charlson合并症指数（比值比1.36，95%置信区间1.12至1.66，P = 0.002）被确定为这些患者术后60天内死亡或新发行走障碍的独立危险因素。在调整虚弱因素后，麻醉方法与这些患者死亡或新发行走障碍的发生无关（P>0.05）。
在不同的虚弱人群中，神经轴索麻醉在术后短期不良结局发生率方面可能与全身麻醉相当。
