Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea.
Department of Psychiatry, Seoul National University Hospital, Seoul, South Korea.
J Affect Disord. 2024 Dec 15;367:696-700. doi: 10.1016/j.jad.2024.09.027. Epub 2024 Sep 10.
Evidence is lacking of an association between anesthetic choice and the risk of psychiatric disorders. Therefore, this study aimed to examine the impact of regional anesthesia (R/A) versus general anesthesia (G/A) on the occurrence of psychiatric disorders in patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA).
Data for this population-based cohort study were sourced from the National Health Insurance Service of South Korea. The study included adult patients who underwent TKA or THA between January 1, 2016, and December 31, 2021. The endpoint was the diagnosis of postoperative psychiatric disorders within 1 year postoperative.
This study included 411,967 patients who underwent THA or TKA. Among them, 290,476 (70.5 %) underwent THA or TKA under R/A (R/A group), while 121,491 (29.5 %) underwent THA or TKA under G/A (G/A group). In multivariate logistic regression, the R/A group had an 8 % lower incidence of postoperative psychiatric disorders (odds ratio [OR], 0.92; 95 % confidence interval [CI], 0.90-0.94; P < 0.001) than the G/A group. Specifically, a lower incidence of postoperative psychiatric disorder for depression (OR, 0.89; 95 % CI, 0.86-0.92; P < 0.001), bipolar disorder (OR, 0.88; 95 % CI, 0.83-0.94; P < 0.001), anxiety disorder (OR, 0.95; 95 % CI, 0.92-0.98; P = 0.001), and insomnia disorder (OR, 0.95; 95 % CI, 0.80-1.11; P = 0.496) was observed in the R/A versus G/A group.
Among these South Korean patients who underwent TKA or THA, the R/A group had a lower incidence of postoperative psychiatric disorders than the G/A group.
目前缺乏关于麻醉选择与精神障碍风险之间关联的证据。因此，本研究旨在探讨区域麻醉（R/A）与全身麻醉（G/A）对接受全膝关节置换术（TKA）或全髋关节置换术（THA）患者发生精神障碍的影响。
本基于人群的队列研究的数据来自韩国国家健康保险服务。研究纳入了 2016 年 1 月 1 日至 2021 年 12 月 31 日期间接受 TKA 或 THA 的成年患者。研究终点为术后 1 年内诊断为术后精神障碍。
本研究纳入了 411967 名接受 THA 或 TKA 的患者。其中，290476 名（70.5%）患者在 R/A 下接受 THA 或 TKA（R/A 组），而 121491 名（29.5%）患者在 G/A 下接受 THA 或 TKA（G/A 组）。多变量逻辑回归分析显示，R/A 组术后精神障碍的发生率比 G/A 组低 8%（比值比[OR]，0.92；95%置信区间[CI]，0.90-0.94；P<0.001）。具体而言，R/A 组术后抑郁（OR，0.89；95%CI，0.86-0.92；P<0.001）、双相障碍（OR，0.88；95%CI，0.83-0.94；P<0.001）、焦虑障碍（OR，0.95；95%CI，0.92-0.98；P=0.001）和失眠障碍（OR，0.95；95%CI，0.80-1.11；P=0.496）的发生率低于 G/A 组。
在这些接受 TKA 或 THA 的韩国患者中，R/A 组术后精神障碍的发生率低于 G/A 组。
