Using local rather than general anesthesia for inguinal hernia repair may significantly reduce complications for frail Veterans.
Using local rather than general anesthesia for inguinal hernia repair may significantly reduce complications for frail Veterans.
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DOI：
10.1016/j.amjsurg.2021.01.026
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发表时间：
2021-09
影响因子：
3
通讯作者：
Balentine CJ
中科院分区：
文献类型：
--
作者：
Meier J;Berger M;Hogan T;Reisch J;Zeh H;Cullum CM;Lee SC;Skinner CS;Brown CJ;Balentine CJ
虚弱容易导致患者术后结局不佳。我们评估了使用局部麻醉而不是全身麻醉进行疝修补术是否可以减轻虚弱的影响。我们使用风险分析指数（RAI）识别了1998-2018年退伍军人事务部手术质量改进计划数据库中的8，038名虚弱患者，这些患者在局部或全身麻醉下接受了择期开放性单侧腹股沟疝修补术。我们关注的结局是术后并发症的发生率。总共有5，188名（65%）患者接受全身麻醉，2，850名（35%）患者接受局部麻醉。局部麻醉与并发症减少48%相关（OR 0.52，95%CI 0.38-0.72）。在最虚弱的患者（RAI≥70）中，全身麻醉的术后并发症的预测概率范围为22-33%，而局部麻醉为13-21%。局部麻醉与虚弱退伍军人术后并发症减少约50%相关。由于缺乏对虚弱患者的干预措施，迫切需要进行一项随机试验，比较麻醉方式对这一脆弱人群术后并发症的影响。
Frailty predisposes patients to poor postoperative outcomes. We evaluated whether using local rather than general anesthesia for hernia repair could mitigate effects of frailty. We used the Risk Analysis Index(RAI) to identify 8,038 frail patients in the 1998–2018 Veterans Affairs Surgical Quality Improvement Program database who underwent elective, open unilateral inguinal hernia repair under local or general anesthesia. Our outcome of interest was the incidence of postoperative complications. In total, 5,188(65%) patients received general anesthesia and 2,850(35%) received local. Local anesthesia was associated with a 48% reduction in complications (OR 0.52, 95%CI 0.38–0.72). Among the frailest patients (RAI≥70), predicted probability of a postoperative complication ranged from 22–33% with general anesthesia, compared to 13–21% with local. Local anesthesia was associated with a ~50% reduction in postoperative complications in frail Veterans. Given the paucity of interventions for frail patients, there is an urgent need for a randomized trial comparing effects of anesthesia modality on postoperative complications in this vulnerable population.
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影响因子：
168.9
作者：
Prestmo, Anders;Hagen, Gunhild;Saltvedt, Ingvild
通讯作者：
Saltvedt, Ingvild
影响因子：
168.9
作者：
Nordin, P;Zetterström, H;Nilsson, E
通讯作者：
Nilsson, E
影响因子：
9
作者：
Barberan-Garcia, Anael;Ubre, Marta;Martinez-Palli, Graciela
通讯作者：
Martinez-Palli, Graciela
影响因子：
4.1
作者：
Lin HS;Watts JN;Peel NM;Hubbard RE
通讯作者：
Hubbard RE
影响因子：
3.1
作者：
Rutkow, IM
通讯作者：
Rutkow, IM