Risk of Parkinson's disease after anaesthesia and surgery.
Risk of Parkinson's disease after anaesthesia and surgery.
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麻醉和手术后患帕金森病的风险。
DOI：
10.1016/j.bja.2021.12.046
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发表时间：
2022
影响因子：
9.8
通讯作者：
Silber,JeffreyH
中科院分区：
文献类型：
--
作者：
Jain,Siddharth;Rosenbaum,PaulR;Reiter,JosephG;Hill,AlexanderS;Wolk,DavidA;Hashemi,Sean;Fleisher,LeeA;Eckenhoff,Roderic;Silber,JeffreyH
编辑——我们之前研究过阑尾炎手术和麻醉的暴露与阿尔茨海默氏病和相关痴呆症 (ADRD) 的后续发展之间的关联。 1 2 我们选择重点关注阑尾切除术，因为阑尾炎似乎相当随机地发生（作为自然实验），并且其后遗症通常不是长期的，这与可能影响长期结果的潜在疾病可能需要的其他手术不同。文献表明，帕金森病 (PD) 和 ADRD 存在共同的神经变性途径。 3-5 我们使用因阑尾炎接受阑尾切除术的同一队列患者和未接受阑尾切除术的相似匹配患者来研究手术暴露和麻醉与腹膜透析之间的关联。这项研究得到了费城儿童医院机构审查委员会的批准。匹配后的协变量平衡显示在补充附录 1 第 1 节中。我们的匹配技术的详细信息之前已发表。 1 简而言之，对于因急性阑尾炎而接受阑尾切除术的 55 000 名老年患者中的每一位，我们将 5 个对照与反映阑尾切除术前健康状况的 211 个协变量进行匹配，并对这些患者进行长达 15 年的跟踪，以确定接受阑尾切除术是否与 PD 发生率增加相关。先前的研究表明，美国老年人 PD 的年发病率为 0.1-0.3%（补充附录 1，第 7 节）。这项研究检测 1.1 的功效 > 80%
Editor—We previously examined the association between the exposure of surgery and anaesthesia for appendicitis and the subsequent development of Alzheimer’s disease and related dementias (ADRD). 1 2 We chose to focus on appendicectomy because appendicitis appears to occur fairly randomly (acting as a natural experiment), and its sequelae are generally not long term, unlike other procedures possibly needed as a result of underlying illnesses that may affect long-term outcomes. Literature has suggested that there are common pathways of neurodegeneration in Parkinson’s disease (PD) and ADRD. 3–5 We used the same cohort of patients who received an appendicectomy for appendicitis with similarly matched patients who did not have an appendicectomy, to investigate an association between exposure to surgery and anaesthesia and PD. This study was approved by the Children's Hospital of Philadelphia Institutional Review Board.Covariate balance after matching is shown in Supplementary Appendix 1, Section 1. The details of our matching techniques were published previously. 1 Briefly, for each of 55 000 older patients undergoing an appendicectomy for acute appendicitis, we matched five controls on 211 covariates reflecting health before the appendicectomy and followed these patients for up to 15 yr to determine if exposure to appendicectomy was associated with an increased rate of PD. Previous studies have suggested a 0.1–0.3% annual incidence rate of PD among older individuals in the USA (Supplementary Appendix 1, Section 7). This study had> 80% power to detect a 1.1