小儿心脏手术使用区域麻醉的国家实践模式：对胸外科学会先天性心脏手术数据库的分析

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-02-08 DOI:10.1016/j.jclinane.2025.111774

Lisa M. Einhorn , Benjamin Y. Andrew , Kevin D. Hill , Levi N. Bonnell , Robert H. Habib , Marshall L. Jacobs , Jeffrey P. Jacobs , David F. Vener , Warwick A. Ames

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引用次数: 0

摘要

背景：小儿心脏手术后疼痛管理欠佳的并发症增加了人们对区域麻醉（RA）的兴趣。我们试图评估全国趋势，并探讨类风湿性关节炎与小儿心脏手术后预后的关系。方法对2016年1月- 2023年5月胸外科学会先天性心脏麻醉学会数据库中18年的患者进行分析。排除非手术室操作和RA数据缺失的记录。收集患者、中心、手术、年份、类风湿关节炎类型和药物的数据，并分析8年研究期间的趋势。通过多变量模型分析了RA与预后的关系，该亚群中没有术前危险因素的儿童接受了指数心房和室间隔缺损（ASD/VSD）修复和Fontan手术。结果该队列包括来自美国62个中心的95,514例手术。RA使用率为8.4% (N = 7997)，从2016年的6.1%增加到2023年的12.5%。发病率最高的病例是1-11岁的儿童，其特点是低风险，并在小容量中心进行。有统计学意义的增加(p <；0.001)，在研究期间，RA在所有年龄组和手术风险类别的使用。虽然神经轴向技术的数量每年保持不变，但非神经轴向技术（即筋膜面阻滞）的数量在研究期间增加了六倍。在亚组分析队列中（N = 7931），与非RA患者相比，进行间隔缺损修复和Fontan手术的RA患者更有可能在手术室拔管(p <；0.001)。与没有RA的患者相比，伴有RA的ASD和VSD患者也更有可能住院时间较短(p <；0.001)。结论：ra在美国儿童心脏手术中的应用正在增加，可能与手术特异性结果的改善有关。

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National practice patterns for the use of regional anesthesia for pediatric cardiac surgery: An analysis of the Society of Thoracic Surgeons congenital heart surgery database

Background

Complications associated with suboptimal pain management after pediatric cardiac surgery have increased interest in regional anesthesia (RA). We sought to evaluate national trends and explore the association of RA with postoperative outcomes following pediatric cardiac surgery.

Methods

Patients <18 years in the Society of Thoracic Surgeons Congenital Cardiac Anesthesia Society Database from 01/2016–05/2023 were analyzed. Non-OR operations and records with missing data on RA were excluded. Data on patients, centers, operations, year, and RA type and medication were collected, and trends over the 8-year study period were analyzed. The association of RA with outcomes was analyzed with multivariable modeling in a subpopulation of children without preoperative risk factors who underwent index atrial and ventricular septal defect (ASD/VSD) repairs and Fontan procedures.

Results

The cohort included 95,514 operations from 62 U.S. centers. RA was used in 8.4 % (N = 7997) and increased annually from 6.1 % in 2016 to 12.5 % in 2023. Prevalence was highest in cases performed in children 1–11 years, characterized as low risk, and conducted low volume centers. There were statistically significant increases (p < 0.001) in RA use across all age groups and surgical risk categories during the study period. While the number of neuraxial techniques remained constant year-to-year, the number of non-neuraxial techniques (i.e., fascial plane blocks) increased sixfold during the study period. In the sub-analysis cohort (N = 7931), patients with RA for septal defect repairs and Fontan procedures were more likely to be extubated in the OR compared to non-RA patients (p < 0.001). ASD and VSD patients with RA were also more likely to have a short length of stay compared to those without RA (p < 0.001).

Conclusions

RA use is increasing in pediatric cardiac surgery in the U.S. and may be associated with surgery-specific outcome improvements.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.