Anesthesia technique, mortality, and length of stay after hip fracture surgery.
Anesthesia technique, mortality, and length of stay after hip fracture surgery.
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DOI：
10.1001/jama.2014.6499
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发表时间：
2014-06-25
影响因子：
120.7
通讯作者：
Silber, Jeffrey H.
中科院分区：
文献类型：
--
作者：
Neuman, Mark D.;Rosenbaum, Paul R.;Ludwig, Justin M.;Zubizarreta, Jose R.;Silber, Jeffrey H.
在美国，每年发生超过30万例髋部骨折。最近的实践指南提倡在髋部骨折手术中更多地使用区域麻醉。测试局部麻醉（即脊髓或硬膜外）与全身麻醉与髋部骨折后30天死亡率和住院时间的关系。我们进行了一项匹配的回顾性队列研究，纳入了2004年7月1日至2011年12月31日期间在纽约州普通急症医院接受髋部骨折手术的50岁及以上患者。我们的主要分析是近距离工具变量匹配，将住在离专门从事区域或全身麻醉的医院不同距离的患者配对。补充分析包括将同一医院的患者配对的院内匹配和将不同医院的患者配对的跨医院匹配。脊髓或硬膜外麻醉；全身麻醉。30天死亡率和住院时间。由于停留时间长度的分布具有长尾，我们使用Huber M估计和Huber权重来表征这一结果，Huber M估计是一种类似于修剪平均值的稳健估计。56 729例患者中，15 904例（28%）采用区域麻醉，40 825例（72%）采用全身麻醉。总体而言，3032名患者（5.3%）死亡。住院时间的M估计为6.2天（95% CI， 6.2至6.2）。近远匹配分析显示，在纳入该匹配的21514例患者中，按麻醉类型划分的30天死亡率无显著差异：住在区域麻醉专科医院附近的10757例匹配患者中有583例（5.4%）死亡，而住在全麻专科医院附近的10757例匹配患者中有629例（5.8%）死亡（工具变量估计风险差异为- 1.1%;95% CI, - 2.8至0.5;P = .20）。对医院内和医院间患者匹配的补充分析得出的死亡率结果与主要分析相似。在近距离匹配中，区域麻醉比全身麻醉的住院时间短0.6天（95% CI,−0.8 ~−0.4,P < 0.001）。补充分析也显示区域麻醉与较短的住院时间相关，尽管观察到的关联在程度上小于主要分析。在纽约州急性护理医院接受髋关节修复的成年人中，与全身麻醉相比，使用区域麻醉与较低的30天死亡率无关，但与较短的住院时间有关。这些发现不支持在这种情况下使用区域麻醉降低死亡率。
More than 300 000 hip fractures occur each year in the United States. Recent practice guidelines have advocated greater use of regional anesthesia for hip fracture surgery. To test the association of regional (ie, spinal or epidural) anesthesia vs general anesthesia with 30-day mortality and hospital length of stay after hip fracture. We conducted a matched retrospective cohort study involving patients 50 years or older who were undergoing surgery for hip fracture at general acute care hospitals in New York State between July 1, 2004, and December 31, 2011. Our main analysis was a near-far instrumental variable match that paired patients who lived at different distances from hospitals that specialized in regional or general anesthesia. Supplementary analyses included a within-hospital match that paired patients within the same hospital and an across-hospital match that paired patients at different hospitals. Spinal or epidural anesthesia; general anesthesia. Thirty-day mortality and hospital length of stay. Because the distribution of length of stay had long tails, we characterized this outcome using the Huber M estimate with Huber weights, a robust estimator similar to a trimmed mean. Of 56 729 patients, 15 904 (28%) received regional anesthesia and 40 825 (72%) received general anesthesia. Overall, 3032 patients (5.3%) died. The M estimate of the length of stay was 6.2 days (95% CI, 6.2 to 6.2). The near-far matched analysis showed no significant difference in 30-day mortality by anesthesia type among the 21 514 patients included in this match: 583 of 10 757 matched patients (5.4%) who lived near a regional anesthesia– specialized hospital died vs 629 of 10 757 matched patients (5.8%) who lived near a general anesthesia–specialized hospital (instrumental variable estimate of risk difference, −1.1%; 95% CI, −2.8 to 0.5; P = .20). Supplementary analyses of within and across hospital patient matches yielded mortality findings to be similar to the main analysis. In the near-far match, regional anesthesia was associated with a 0.6-day shorter length of stay than general anesthesia (95% CI, −0.8 to −0.4, P < .001). Supplementary analyses also showed regional anesthesia to be associated with shorter length of stay, although the observed association was smaller in magnitude than in the main analysis. Among adults in acute care hospitals in New York State undergoing hip repair, the use of regional anesthesia compared with general anesthesia was not associated with lower 30-day mortality but was associated with a modestly shorter length of stay. These findings do not support a mortality benefit for regional anesthesia in this setting.
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影响因子：
8.8
作者：
Neuman, Mark D.;Silber, Jeffrey H.;Fleisher, Lee A.
通讯作者：
Fleisher, Lee A.
影响因子：
3.7
作者：
Angrist, JD;Imbens, GW;Rubin, DB
通讯作者：
Rubin, DB
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN
DOI：
10.1111/j.1467-985x.2004.00339.x
发表时间：
2005-01-01
影响因子：
2
作者：
Imbens, GW;Rosenbaum, PR
通讯作者：
Rosenbaum, PR
影响因子：
1.9
作者：
Rosenbaum, Paul R.
通讯作者：
Rosenbaum, Paul R.