Meng Fanqiang, Wang Yuqing, Shen Liusong, Sheng Junzhi, Long Huizhong, Chen Hu, Li Xiaoxiao, Xie Dongxing, Ding Xiang
From the Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Tibet Autonomous Region People's Hospital, Lhasa, Tibet, China.
Anesth Analg. 2025 Sep 26. doi: 10.1213/ANE.0000000000007758.
Anesthesia choice affects hip fracture surgery outcomes. However, limited evidence exists regarding the impact of neuraxial anesthesia (NA) versus general anesthesia (GA) on postoperative outcomes, specifically in hip arthroplasty for fracture. The purpose of this study was to compare 30-day readmission, in-hospital complications, hospitalization charges, and length of stay between the elderly who received NA and GA during this procedure.
The Hospital Quality Monitoring System was analyzed for patients undergoing hip arthroplasty for geriatric hip fracture (≥60 years of age) between 2013 and 2019. After adjusting for potential confounders with propensity score matching, logistic regression and linear regression analyses were conducted to compare NA with GA in terms of 30-day readmission rates and causes, in-hospital complications (including in-hospital mortality, pulmonary embolism, deep vein thrombosis, wound infection, and blood transfusion), hospitalization charges, and length of stay.
Of the 90,745 patients undergoing hip arthroplasty for geriatric hip fracture during the study period (40,551 [44.7%] for NA, 50,194 [55.3%] for GA), a total of 62,022 patients (31,011 propensity score-matched pairs) were included after study exclusions and propensity score matching. NA was significantly associated with a lower incidence of 30-day readmission (4.60% vs 4.97%, odds ratio [OR] = 0.92, 95% confidence interval [CI], 0.86-0.99, P =.032) and fewer genitourinary system complaints (0.18% vs 0.26%, OR = 0.70, 95% CI, 0.50-0.97, P =.035) for readmission compared with GA. The incidence of in-hospital mortality (0.41% vs 0.64%, OR = 0.64, 95% CI, 0.52-0.81, P <.001), deep vein thrombosis (1.84% vs 2.57%, OR = 0.71, 95% CI, 0.64-0.79, P <.001), and pulmonary embolism (0.22% vs 0.38%, OR = 0.58, 95% CI, 0.43-0.79, P <.001) was also lower for NA compared with GA. Moreover, patients with NA had decreased charges (49,851.8 Chinese Yuan [CNY] vs 54,754.8 CNY, P <.001) relative to GA. The length of stay did not differ significantly between NA and GA (13.7 days vs 13.8 days, P =.217).
In geriatric patients undergoing hip arthroplasty for hip fracture, NA is associated with lower rates of 30-day readmission, fewer readmission caused by genitourinary system complaints, reduced complications, and decreased hospitalization charges compared to GA.
麻醉方式的选择会影响髋部骨折手术的结果。然而，关于神经轴索麻醉（NA）与全身麻醉（GA）对术后结果的影响，尤其是在骨折髋部置换术中，证据有限。本研究的目的是比较在此手术过程中接受NA和GA的老年人的30天再入院率、住院并发症、住院费用和住院时间。
分析2013年至2019年期间接受老年髋部骨折（≥60岁）髋部置换术患者的医院质量监测系统。在通过倾向得分匹配调整潜在混杂因素后，进行逻辑回归和线性回归分析，以比较NA和GA在30天再入院率及原因、住院并发症（包括住院死亡率、肺栓塞、深静脉血栓形成、伤口感染和输血）、住院费用和住院时间方面的差异。
在研究期间接受老年髋部骨折髋部置换术的90745例患者中（NA组40551例[44.7%]，GA组50194例[55.3%]），经过研究排除和倾向得分匹配后，共纳入62022例患者（31011对倾向得分匹配对）。与GA相比，NA与30天再入院率较低（4.60%对4.97%，优势比[OR]=0.92，95%置信区间[CI]，0.86 - 0.99，P = 0.032）以及再入院时泌尿生殖系统投诉较少（0.18%对0.26%，OR = 0.70，95% CI，0.50 - 0.97，P = 0.035）显著相关。与GA相比，NA的住院死亡率（0.41%对0.64%，OR = 0.64，95% CI，0.52 - 0.81，P < 0.001）、深静脉血栓形成（1.84%对2.57%，OR = 0.71，95% CI，0.64 - 0.79，P < 0.001）和肺栓塞（0.22%对0.38%，OR = 0.58，95% CI，0.43 - 0.79，P < 0.001）发生率也较低。此外，与GA相比，NA患者的费用降低（49851.8元人民币对54754.8元人民币，P < 0.001）。NA和GA之间的住院时间无显著差异（13.7天对13.8天，P = 0.217）。
在接受髋部骨折髋部置换术的老年患者中，与GA相比，NA与较低的30天再入院率、较少的泌尿生殖系统投诉导致的再入院、减少的并发症以及降低的住院费用相关。
