麻醉方法与因体质虚弱而导致的术后短期不良后果之间的相关性：前瞻性队列研究

IF 3.6 3区医学

Clinical Interventions in Aging Pub Date : 2024-04-16 DOI:10.2147/cia.s448898

Yan Feng, Jia-Feng Sun, Hai-Chao Wei, Ying Cao, Lei Yao, Bo-Xiang Du

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引用次数: 0

摘要

目的：本研究旨在探讨骨科大手术中使用的麻醉类型会如何根据虚弱程度影响术后短期不良预后：为了开展这项调查，我们招募了 2022 年 3 月至 2023 年 4 月期间在一家机构接受大型骨科手术的 65 岁及以上的患者。我们使用 FRAIL 量表来评估虚弱程度。主要关注手术后 60 天内死亡或无法行走的情况。次要衡量指标包括：60天内死亡；60天后在无人协助的情况下无法行走；术后30天内死亡或在无人协助的情况下无法行走、术后首次下床活动时间、术后输血量、住院时间、住院费用以及手术并发症的发生率，如脱位、假体周围骨折、感染、再次手术、伤口并发症/血肿等：在对 387 名接受过大型骨科手术的老年成人患者进行的研究中发现，41.3% 的患者处于虚弱状态。在这些患者中，262 人进行了全身麻醉，125 人进行了神经轴麻醉。多因素逻辑回归分析表明，麻醉类型与并发症无关。相反，虚弱（OR 4.04，95% CI 1.04 至 8.57，P< 0.001）、年龄（OR 1.05，95% CI 1.00 至 1.10，P= 0.017）和 aCCI 评分（年龄调整后的夏尔森疾病指数）（OR 1.36，95% CI 1.12 至 1.66，P= 0.002）被认为是这些患者术后 60 天死亡或出现新的行走障碍的独立风险因素。在对虚弱程度进行调整后，麻醉方法与这些患者的死亡或新出现的行走障碍无关（P> 0.05）：在不同的体弱人群中，神经麻醉在术后短期不良后果的发生率方面可能与全身麻醉相当。关键词：麻醉；体弱；骨科大手术；死亡；行走能力受损

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Correlation Between Anesthesia Methods and Adverse Short-Term Postoperative Outcomes Depending on Frailty: A Prospective Cohort Study

Purpose: This study aims to investigate how the type of anesthesia used during major orthopedic surgery may impact adverse short-term postoperative outcomes depending on frailty.
Methods: To conduct this investigation, we recruited individuals aged 65 years and older who underwent major orthopedic surgery between March 2022 and April 2023 at a single institution. We utilized the FRAIL scale to evaluate frailty. The primary focus was on occurrences of death or the inability to walk 60 days after the surgery. Secondary measures included death within 60 days; inability to walk without human assistance at 60 days; death or the inability to walk without human assistance at 30 days after surgery, the first time out of bed after surgery, postoperative blood transfusion, length of hospital stay, hospital costs, and the occurrence of surgical complications such as dislocation, periprosthetic fracture, infection, reoperation, wound complications/hematoma.
Results: In a study of 387 old adult patients who had undergone major orthopedic surgery, 41.3% were found to be in a frail state. Among these patients, 262 had general anesthesia and 125 had neuraxial anesthesia. Multifactorial logistic regression analyses showed that anesthesia type was not linked to complications. Instead, frailty (OR 4.04, 95% CI 1.04 to 8.57, P< 0.001), age (OR 1.05, 95% CI 1.00– 1.10, P= 0.017), and aCCI scores, age-adjusted Charlson Comorbidity Index, (OR 1.36, 95% CI 1.12 to 1.66, P= 0.002) were identified as independent risk factors for death or new walking disorders in these patients 60 days after surgery. After adjusting for frailty, anesthesia methods was not associated with the development of death or new walking disorders in these patients (P > 0.05).
Conclusion: In different frail populations, neuraxial anesthesia is likely to be comparable to general anesthesia in terms of the incidence of short-term postoperative adverse outcomes.

Keywords: anesthesia, frailty, major orthopedic surgery, death, impaired walking ability

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来源期刊

Clinical Interventions in Aging GERIATRICS & GERONTOLOGY-

CiteScore

6.20

自引率

2.80%

发文量

193

期刊介绍： Clinical Interventions in Aging, is an online, peer reviewed, open access journal focusing on concise rapid reporting of original research and reviews in aging. Special attention will be given to papers reporting on actual or potential clinical applications leading to improved prevention or treatment of disease or a greater understanding of pathological processes that result from maladaptive changes in the body associated with aging. This journal is directed at a wide array of scientists, engineers, pharmacists, pharmacologists and clinical specialists wishing to maintain an up to date knowledge of this exciting and emerging field.