Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, South Korea.
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, 13620, South Korea.
BMC Anesthesiol. 2024 Nov 27;24(1):433. doi: 10.1186/s12871-024-02831-z.
The optimal type of anesthesia for reducing postoperative delirium remains undetermined. This study aimed to assess the relationship between type of anesthesia and postoperative delirium.
This retrospective national cohort study used data collected between 2016 and 2021 from the National Health Insurance Service of South Korea. Adult patients who underwent primary total hip or total knee arthroplasty under general or regional anesthesia were included. Patients with postoperative delirium were identified after arthroplasty according to the International Classification of Diseases 10th revision code for delirium (F05). The patients were divided into two groups: regional anesthesia (RA group) and general anesthesia (GA group). The primary endpoint was the incidence of postoperative delirium during hospitalization after total hip or knee arthroplasty.
Our study sample consisted of 664,598 patients: 474,932 in the RA group and 189,666 in the GA group. After propensity score (PS) matching, 276,582 patients (138,291 in each group) were included in the final analysis. In the PS-matched cohort, the incidence of delirium following total knee or total hip arthroplasty was 2.8% (3,842/138,291) in the GA group and 2.3% (3,147/138,291) in the RA group. In logistic regression, the RA group was associated with 18% (odds ratio: 0.82, 95% confidence interval: 0.78, 0.86; P < 0.001) lower postoperative incidence than the GA group.
Compared to general anesthesia, regional anesthesia was associated with a decreased incidence of postoperative delirium in patients who underwent total hip or total knee arthroplasty. Our findings indicate that avoiding general anesthesia may prevent delirium after lower limb surgery.
降低术后谵妄的最佳麻醉类型仍未确定。本研究旨在评估麻醉类型与术后谵妄之间的关系。
这是一项使用韩国国家健康保险服务于 2016 年至 2021 年期间收集的数据进行的回顾性全国队列研究。纳入在全身麻醉或区域麻醉下接受初次全髋关节或全膝关节置换术的成年患者。根据国际疾病分类第 10 版谵妄代码（F05），在关节置换术后确定术后谵妄患者。患者分为两组：区域麻醉（RA 组）和全身麻醉（GA 组）。主要终点是全髋关节或全膝关节置换术后住院期间发生术后谵妄的发生率。
我们的研究样本包括 664598 名患者：RA 组 474932 名，GA 组 189666 名。在进行倾向评分（PS）匹配后，最终分析纳入 276582 名患者（每组 138291 名）。在 PS 匹配队列中，GA 组全膝关节或全髋关节置换术后谵妄发生率为 2.8%（3842/138291），RA 组为 2.3%（3147/138291）。在逻辑回归中，RA 组与 GA 组相比，术后谵妄发生率降低 18%（优势比：0.82，95%置信区间：0.78，0.86；P<0.001）。
与全身麻醉相比，区域麻醉与全髋关节或全膝关节置换术后谵妄发生率降低相关。我们的研究结果表明，避免全身麻醉可能预防下肢手术后谵妄。
