Tanios Anna-Marie G, Gallagher Emily L, McManus Michael S, Riordan John A, Harris Ian A, Harvey Lara A
Mater Health Services, Brisbane, Australia.
Neuroscience Research Australia (NeuRA), Sydney, Australia.
Anaesth Intensive Care. 2025 Mar;53(2):116-124. doi: 10.1177/0310057X241275116. Epub 2025 Jan 6.
Delirium is the most common in-hospital complication affecting older adults with acute hip fractures. Current evidence demonstrates inconsistent associations between anaesthetic type for acute hip fracture surgery and postoperative delirium. Using the Australian and New Zealand Hip Fracture Registry database, we conducted a retrospective cohort study of patients aged 50 years and over who underwent acute hip fracture surgery between 2015 and 2020. The incidence of delirium in patients who received general anaesthesia alone or combined with a regional technique, versus those who received spinal or regional anaesthesia was assessed. Multivariable multilevel logistic regression was used to test associations between anaesthetic type and delirium controlling for known confounders. Finally, given hospital variation in preference for anaesthetic type, an instrumental variable analysis was performed to include the effect of both known and unknown confounding. Of 35,252 patients, 25,682 (72.9%) patients received general anaesthesia, and 9570 (27.2%) patients received spinal or regional anaesthesia for their hip fracture surgery. A higher proportion of patients who received general anaesthesia developed delirium than those who received spinal or regional anaesthesia (40.6% vs. 35.7%, odds ratio (OR) 1.23, 95% confidence intervals (CI) 1.18 to 1.30, < 0.0001). After adjusting for known confounders, general anaesthesia patients were at slightly increased odds of developing delirium (OR 1.14, 95% CI 1.04 to 1.25, = 0.0052). However, the instrumental variable analysis found no statistically significant difference between groups (OR 1.03, 95% CI 0.99 to 1.07, = 0.141). Therefore, while a weak association was found between general anaesthesia exposure and postoperative delirium, an instrumental variable analysis to compensate for unmeasured confounding showed no causal association between general anaesthesia and postoperative delirium.
谵妄是影响急性髋部骨折老年患者的最常见院内并发症。目前的证据表明，急性髋部骨折手术的麻醉类型与术后谵妄之间的关联并不一致。我们利用澳大利亚和新西兰髋部骨折注册数据库，对2015年至2020年间接受急性髋部骨折手术的50岁及以上患者进行了一项回顾性队列研究。评估了单纯接受全身麻醉或联合区域技术的患者与接受脊髓或区域麻醉的患者的谵妄发生率。采用多变量多水平逻辑回归分析来检验麻醉类型与谵妄之间的关联，并对已知的混杂因素进行控制。最后，考虑到医院在麻醉类型偏好上的差异，进行了工具变量分析，以纳入已知和未知混杂因素的影响。在35252例患者中，25682例（72.9%）患者接受了全身麻醉，9570例（27.2%）患者接受了脊髓或区域麻醉进行髋部骨折手术。接受全身麻醉的患者发生谵妄的比例高于接受脊髓或区域麻醉的患者（40.6%对35.7%，优势比（OR）1.23，95%置信区间（CI）1.18至1.30，P＜0.0001）。在对已知混杂因素进行调整后，全身麻醉患者发生谵妄的几率略有增加（OR 1.14，95%CI 1.04至1.25，P = 0.0052）。然而，工具变量分析发现两组之间无统计学显著差异（OR 1.03，95%CI 0.99至1.07，P = 0.141）。因此，虽然发现全身麻醉暴露与术后谵妄之间存在微弱关联，但用于补偿未测量混杂因素的工具变量分析显示全身麻醉与术后谵妄之间无因果关联。
