Comparative Effectiveness of Regional versus General Anesthesia for Hip Fracture Surgery in Adults
Comparative Effectiveness of Regional versus General Anesthesia for Hip Fracture Surgery in Adults
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DOI：
10.1097/aln.0b013e3182545e7c
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发表时间：
2012-07-01
期刊：
影响因子：
8.8
通讯作者：
Fleisher, Lee A.
中科院分区：
文献类型：
--
作者：
Neuman, Mark D.;Silber, Jeffrey H.;Fleisher, Lee A.
背景：髋部骨折在老年人中是一种常见的、病态的和昂贵的事件。数据是不确定的，是否硬膜外或脊髓（区域）麻醉改善髋关节骨折surgery.Methods后的结果：作者研究了一个回顾性队列的患者接受髋关节骨折手术在纽约的126家医院在2007年和2008年。他们使用医院固定效应logistic回归检验了表明接受区域麻醉和全身麻醉的记录与住院患者死亡率的主要结局以及与肺和心血管并发症的次要结局的关联。亚组分析根据骨折解剖结构测试麻醉类型和结果之间的关系。结果：在18,158名患者中，5,254名（29%）接受了区域麻醉。435例（2.4%）发生院内死亡。未校正的死亡率和心血管并发症的发生率在不同麻醉类型之间没有差异。接受区域麻醉的患者发生肺部并发症较少（359例[6.8%] vs. 1，040例[8.1%]，P < 0.005）。与全身麻醉相比，区域麻醉与较低的死亡率（比值比：0.710，95% CI 0.541，0.932，P = 0.014）和肺部并发症（比值比：0.752，95% CI 0.637，0.887，P < 0.0001）相关。在亚组分析中，区域麻醉与股骨粗隆间骨折患者生存率的提高和肺部并发症的减少相关，但与股骨颈fraction.Conclusions患者无关：与全身麻醉相比，区域麻醉与所有髋部骨折患者住院死亡率和肺部并发症的降低相关;这一发现可能是由于区域麻醉在股骨转子间骨折患者中的效果改善的趋势。
Background: Hip fracture is a common, morbid, and costly event among older adults. Data are inconclusive as to whether epidural or spinal (regional) anesthesia improves outcomes after hip fracture surgery.Methods: The authors examined a retrospective cohort of patients undergoing surgery for hip fracture in 126 hospitals in New York in 2007 and 2008. They tested the association of a record indicating receipt of regional versus general anesthesia with a primary outcome of inpatient mortality and with secondary outcomes of pulmonary and cardiovascular complications using hospital fixed-effects logistic regressions. Subgroup analyses tested the association of anesthesia type and outcomes according to fracture anatomy.Results: Of 18,158 patients, 5,254 (29%) received regional anesthesia. In-hospital mortality occurred in 435 (2.4%). Unadjusted rates of mortality and cardiovascular complications did not differ by anesthesia type. Patients receiving regional anesthesia experienced fewer pulmonary complications (359 [6.8%] vs. 1,040 [8.1%], P < 0.005). Regional anesthesia was associated with a lower adjusted odds of mortality (odds ratio: 0.710, 95% CI 0.541, 0.932, P = 0.014) and pulmonary complications (odds ratio: 0.752, 95% CI 0.637, 0.887, P < 0.0001) relative to general anesthesia. In subgroup analyses, regional anesthesia was associated with improved survival and fewer pulmonary complications among patients with intertrochanteric fractures but not among patients with femoral neck fractures.Conclusions: Regional anesthesia is associated with a lower odds of inpatient mortality and pulmonary complications among all hip fracture patients compared with general anesthesia; this finding may be driven by a trend toward improved outcomes with regional anesthesia among patients with intertrochanteric fractures.