Zhong Gengrui, Huang Xiaoli, Li Congye, Wang Deqiang, Huang Dingding, Sun Menghan, Zhou Quanhong, Guo Yong
Department of Critical Care Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Critical Care Medicine, Jinshan Branch of Shanghai Sixth People's Hospital (Shanghai Jinshan District Central Hospital), Shanghai, China.
Front Med (Lausanne). 2025 Aug 11;12:1599989. doi: 10.3389/fmed.2025.1599989. eCollection 2025.
To evaluate the effects of various anesthesia techniques on perioperative neurocognitive disorders (PND) and other postoperative complications in elderly patients undergoing hemiarthroplasty for hip fractures.
This multicenter retrospective observational study analyzed 5,005 elderly patients (≥65 years) with hip fractures who underwent hemiarthroplasty and had complete perioperative clinical data. Patients were categorized into five anesthesia groups: a, Combined intravenous-inhalation anesthesia (IVA + IHA); b, IVA + IHA with peripheral nerve block (PNB); c, Intravenous anesthesia (IVA) with PNB; d, Spinal anesthesia (SA); e, SA with PNB. Postoperative delirium (POD) was assessed twice daily during the first 3 postoperative days using the Confusion Assessment Method (CAM). Delayed neurocognitive recovery (DNR) was evaluated via telephone follow-up on postoperative day 7. Other postoperative complications, as well as 30-day and 6-month mortality rates, were systematically recorded.
The analysis revealed no significant differences in POD incidence among the first three anesthesia groups (a/b/c) or between the last two groups (d/e) ( > 0.05). However, when comparing the combined first three groups with the combined last two groups, the difference was statistically significant ( < 0.05), with an overall -value of 0.029. No significant differences were observed in DNR incidence among the five groups ( = 0.12), indicating that anesthesia methods significantly affected POD occurrence but not DNR. Significant differences were found in postoperative pulmonary infection (PI) rates among the five anesthesia groups ( = 0.0314). The overall PI incidence was significantly higher in general anesthesia groups compared to regional anesthesia groups, with notable differences in pairwise comparisons. However, no significant differences were observed in urinary tract infection (UTI), deep vein thrombosis (DVT), pulmonary thromboembolism (PTE), or mortality rates among the groups ( > 0.05). SA & SA + PNB (de) significantly reduced POD risk: SA: OR 0.3239 (95% CI 0.2215-0.4735), 67.61% risk reduction; SA + PNB: OR 0.3634 (95% CI 0.2966-0.4452), 63.66% risk reduction (Both statistically significant, CI excludes 1). IVA + IHA: OR 1.3929 (95% CI 1.0590-1.8320) suggested potential PI risk increase, but wider CI indicates lower certainty.
These findings suggest that regional anesthesia may be associated with lower early POD and pulmonary infection rates. Further prospective randomized controlled trials are needed to validate these results.
评估不同麻醉技术对老年髋部骨折行半髋关节置换术患者围手术期神经认知障碍（PND）及其他术后并发症的影响。
本多中心回顾性观察研究分析了5005例年龄≥65岁、行半髋关节置换术且围手术期临床资料完整的老年髋部骨折患者。患者被分为五个麻醉组：a，静吸复合麻醉（IVA + IHA）；b，静吸复合麻醉联合外周神经阻滞（PNB）；c，静脉麻醉（IVA）联合PNB；d，脊髓麻醉（SA）；e，脊髓麻醉联合PNB。术后谵妄（POD）在术后第1至3天每天使用意识模糊评估法（CAM）评估两次。术后第7天通过电话随访评估延迟性神经认知恢复（DNR）。系统记录其他术后并发症以及30天和6个月死亡率。
分析显示前三个麻醉组（a/b/c）之间或后两个组（d/e）之间POD发生率无显著差异（P>0.05）。然而，将前三组与后两组合并比较时，差异具有统计学意义（P<0.05），总体P值为0.029。五组之间DNR发生率无显著差异（P = 0.12），表明麻醉方法对POD的发生有显著影响，但对DNR无影响。五组术后肺部感染（PI）率存在显著差异（P = 0.0314）。与区域麻醉组相比，全身麻醉组的总体PI发生率显著更高，两两比较有显著差异。然而，各组之间尿路感染（UTI）、深静脉血栓形成（DVT）、肺血栓栓塞（PTE）或死亡率无显著差异（P>0.05）。SA及SA + PNB（d/e）显著降低POD风险：SA：OR 0.3239（95%CI 0.2215 - 0.4735），风险降低67.61%；SA + PNB：OR 0.3634（95%CI 0.2966 - 0.4452），风险降低63.66%（均具有统计学意义，CI不包括1）。IVA + IHA：OR 1.3929（95%CI 1.0590 - 1.8320）提示PI风险可能增加，但CI较宽表明确定性较低。
这些发现表明区域麻醉可能与较低的早期POD和肺部感染率相关。需要进一步的前瞻性随机对照试验来验证这些结果。
