Anesthetic Management and Surgical Site Infections in Total Hip or Knee Replacement A Population-based Study
Anesthetic Management and Surgical Site Infections in Total Hip or Knee Replacement A Population-based Study
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DOI：
10.1097/aln.0b013e3181e2c1c3
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发表时间：
2010-08-01
期刊：
影响因子：
8.8
通讯作者：
Lin, Herng-Ching
中科院分区：
文献类型：
--
作者：
Chang, Chuen-Chau;Lin, Hsiu-Chen;Lin, Herng-Ching
背景：硬膜外或脊髓麻醉涉及几种机制，假设在这一决定性时期降低手术部位感染（ssi）的风险。本研究旨在比较在全身麻醉下接受全髋关节或膝关节置换术的患者与硬膜外麻醉或脊髓麻醉的患者术后30天内发生SSI的风险。方法：采用台湾健康保险纵向数据库。从2002年到2006年，共有3081名患者接受了原发性全髋关节或膝关节置换术。采用多因素logistic回归和倾向评分分析探讨手术麻醉方式与术后30天内发生SSI的关系。结果：在3081例样本患者中，56例（1.8%）有30天ssi；其中全麻33例（占全麻2.8%），硬膜外或脊髓麻醉23例（占硬膜外或脊髓麻醉1.2%）（P = 0.002）。在调整患者的年龄、性别、手术年份、合共病、外科医生年龄和医院教学状况后，全麻下接受全髋关节或膝关节置换术的患者发生SSI的几率是硬膜外或脊髓麻醉下相同手术的患者的2.21倍（95% CI = 1.25-3.90, P = 0.007）。结论：与硬膜外麻醉或脊髓麻醉相比，全麻下的全髋关节或膝关节置换术与SSI的高风险相关。我们的研究结果支持了麻醉长期后果的发展概念，并强调了麻醉师在预防ssi中的作用。
Background: Epidural or spinal anesthesia involves several mechanisms hypothesized to reduce risk of surgical site infections (SSIs) during this decisive period. This study aims to compare the risk of SSI within 30 days of surgery for patients receiving total hip or knee replacement under general anesthesia versus those under epidural or spinal anesthesia.Methods: We used the Longitudinal Health Insurance Database of Taiwan. A total of 3,081 patients who underwent primary total hip or knee replacement from 2002 to 2006 were included in the study. Multivariate logistic regression and propensity score analyses were carried out to explore the relationship between method of surgical anesthesia and SSI occurring within 30 days of surgery.Results: Of the 3,081 sampled patients, 56 patients (1.8%) had 30-day SSIs; 33 (2.8% of all under general anesthesia) of them had general anesthesia, and 23 (1.2% of all under epidural or spinal anesthesia) had epidural or spinal anesthesia (P = 0.002). The odds of SSI for patients receiving total hip or knee replacement under general anesthesia were 2.21 (95% CI = 1.25-3.90, P = 0.007) times higher than those who had the same procedure under epidural or spinal anesthesia, after adjusting for the patient's age, sex, the year of surgery, comorbidities, surgeon's age, and hospital teaching status.Conclusions: Total hip or knee replacement under general anesthesia is associated with higher risk of SSI compared with epidural or spinal anesthesia. Our results support the evolving concept of long-term consequences of anesthesia and emphasize the anesthesiologist's role in preventing SSIs.