Qian Daniel, Olumuyide Ezekiel, Keswani Aakash, Lin Hung-Mo, Ouyang Yuxia, DeMaria Samuel, Poeran Jashvant, Park Chang H, Burnett Garrett W
Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
J Clin Med. 2024 Jul 9;13(14):3999. doi: 10.3390/jcm13143999.
: The use of neuraxial anesthesia versus general anesthesia for hip fracture surgery remains an active area of research, with recent studies demonstrating mixed findings supporting neuraxial over general anesthesia. The benefits of neuraxial anesthesia have been documented in associated surgeries, including total joint arthroplasty. However, racial disparities in the administration of neuraxial anesthesia have been identified in numerous procedures. We aimed to examine the association of race/ethnicity with neuraxial anesthesia use and the effect of neuraxial anesthesia on length of stay, non-home discharge, 30-day severe adverse events, and rates of readmission among patients undergoing isolated hip and femoral shaft fracture operations. : The American College of Surgeons National Quality Improvement Program database was queried for isolated hip or femoral shaft fractures from 2015 to 2019. Stepwise logistic regression was performed to assess the relationship between race/ethnicity and neuraxial anesthesia use. Within each sex-race stratum, neuraxial anesthesia recipients were propensity-matched to general anesthesia recipients in a 1:2 ratio. Logistic regression and negative binomial regression were performed on the propensity-matched cohort. : A total of 12,004 neuraxial and 64,250 general anesthesia hip and femoral shaft fracture patients were identified. Compared to White patients, Black and Hispanic patients were between 0.64 and 0.61 times less likely to receive neuraxial anesthesia over general anesthesia, respectively ( < 0.05). 11,993 patients who received neuraxial anesthesia were propensity matched to 23,946 patients who received general anesthesia. Propensity-matched logistic regressions found that neuraxial anesthesia was associated with decreased length of stay, 30-day severe adverse events, and acute rehab/skilled nursing facility discharge for White patients ( < 0.05 for all), but only decreased length of stay in Black and Hispanic patients ( = 0.01 and = 0.02, respectively). : Notable disparities exist in the administration of neuraxial anesthesia for isolated hip and femoral shaft fracture patients. Hispanic and Black race/ethnicity in particular influences provision of neuraxial anesthesia. Further research is required to understand the degree of effect modification and root causes of regional anesthesia access and benefits for this high-volume patient population.
在髋部骨折手术中，使用神经轴索麻醉与全身麻醉相比仍是一个活跃的研究领域，最近的研究结果不一，但有研究支持神经轴索麻醉优于全身麻醉。神经轴索麻醉的益处已在包括全关节置换术在内的相关手术中得到证实。然而，在许多手术中已发现神经轴索麻醉的使用存在种族差异。我们旨在研究种族/民族与神经轴索麻醉使用之间的关联，以及神经轴索麻醉对接受单纯髋部和股骨干骨折手术患者的住院时间、非回家出院、30天严重不良事件和再入院率的影响。
查询了美国外科医师学会国家质量改进计划数据库中2015年至2019年的单纯髋部或股骨干骨折病例。采用逐步逻辑回归分析评估种族/民族与神经轴索麻醉使用之间的关系。在每个性别-种族分层中，将接受神经轴索麻醉的患者与接受全身麻醉的患者按1:2的比例进行倾向评分匹配。对倾向评分匹配队列进行逻辑回归和负二项回归分析。
共识别出12004例接受神经轴索麻醉和64250例接受全身麻醉的髋部和股骨干骨折患者。与白人患者相比，黑人和西班牙裔患者接受神经轴索麻醉而非全身麻醉的可能性分别降低了0.64倍和0.61倍（均<0.05）。11993例接受神经轴索麻醉的患者与23946例接受全身麻醉的患者进行了倾向评分匹配。倾向评分匹配的逻辑回归分析发现，神经轴索麻醉与白人患者住院时间缩短、30天严重不良事件减少以及急性康复/专业护理机构出院率降低相关（均<0.05），但仅与黑人和西班牙裔患者住院时间缩短相关（分别为P = 0.01和P = 0.02）。
在单纯髋部和股骨干骨折患者的神经轴索麻醉使用方面存在显著差异。特别是西班牙裔和黑人种族/民族影响神经轴索麻醉的提供。需要进一步研究以了解效应修饰程度以及该大量患者群体区域麻醉可及性和益处的根本原因。
