Ho Chun-Ning, Wang Wei-Ting, Hung Kuo-Chuan, Liu Wei-Cheng, Liao Shu-Wei, Chen Jen-Yin, Lan Kuo-Mao
School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan.
Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan.
Anaesthesia. 2025 May;80(5):488-498. doi: 10.1111/anae.16511. Epub 2024 Dec 12.
General anaesthesia and regional anaesthesia are used for hip and knee arthroplasty but their impact on long-term outcomes remains unclear. This study aimed to compare one-year clinical outcomes and healthcare utilisation in patients receiving general or regional anaesthesia for hip or knee arthroplasty.
Using data from the TriNetX Global Collaborative Network, we conducted a retrospective analysis of 247,142 patients aged 40-90 y who underwent hip or knee arthroplasty between 2010 and 2023. After propensity score matching, 12,558 patients were included in the general anaesthesia and regional anaesthesia cohorts. The primary outcome was one-year all-cause mortality. Secondary outcomes included one-year incidence of dementia; cerebral infarction; pneumonia; major depression; care provider dependency; and readmission rates. Subgroup analyses according to sex, age (40-70 y vs. > 70 y) and timeframe (2010-2016 vs. 2017-2023) were also performed.
There was no significant difference in one-year mortality (hazard ratio 1.12, 95%CI 0.89-1.41, p = 0.322). General anaesthesia was associated with a lower incidence of major depression (hazard ratio 0.82, 95%CI 0.70-0.97, p = 0.021) and care provider dependency (hazard ratio 0.47, 95%CI 0.38-0.58, p < 0.001), but higher readmission rates (hazard ratio 1.22, 95%CI 1.16-1.29, p < 0.001) than regional anaesthesia. Subgroup analysis revealed that patient characteristics including sex and age, as well as evolving peri-operative care practices over time, may influence the comparative outcomes of general and regional anaesthesia in patients undergoing elective hip or knee arthroplasty.
Although general anaesthesia and regional anaesthesia showed comparable one-year mortality, general anaesthesia was associated with lower risks of major depression and care provider dependency but higher readmission rates than regional anaesthesia. These findings suggest that the choice of anaesthesia may have important implications for long-term outcomes beyond mortality.
全身麻醉和区域麻醉用于髋关节和膝关节置换术，但其对长期预后的影响尚不清楚。本研究旨在比较接受全身或区域麻醉进行髋关节或膝关节置换术患者的一年临床结局和医疗资源利用情况。
利用TriNetX全球合作网络的数据，我们对2010年至2023年间年龄在40 - 90岁接受髋关节或膝关节置换术的247,142例患者进行了回顾性分析。经过倾向得分匹配后，全身麻醉组和区域麻醉组纳入了12,558例患者。主要结局是一年全因死亡率。次要结局包括一年痴呆发病率；脑梗死；肺炎；重度抑郁症；护理人员依赖；以及再入院率。还根据性别、年龄（40 - 70岁与> 70岁）和时间范围（2010 - 2016年与2017 - 2023年）进行了亚组分析。
一年死亡率无显著差异（风险比1.12，95%置信区间0.89 - 1.41，p = 0.322）。全身麻醉与重度抑郁症发病率较低（风险比0.82，95%置信区间0.70 - 0.97，p = 0.021）和护理人员依赖较低（风险比0.47，95%置信区间0.38 - 0.58，p < 0.001）相关，但与区域麻醉相比再入院率较高（风险比1.22，95%置信区间1.16 - 1.29，p < 0.001）。亚组分析显示，包括性别和年龄在内的患者特征，以及随着时间推移不断变化的围手术期护理实践，可能会影响接受择期髋关节或膝关节置换术患者全身麻醉和区域麻醉的比较结局。
虽然全身麻醉和区域麻醉显示出相当的一年死亡率，但全身麻醉与重度抑郁症和护理人员依赖风险较低相关，但与区域麻醉相比再入院率较高。这些发现表明，麻醉方式的选择可能对死亡率以外的长期结局有重要影响。
