Short-term outcomes of combined neuraxial and general anaesthesia versus general anaesthesia alone for elective open abdominal aortic aneurysm repair: retrospective population-based cohort study

被引：9

作者：

Salata, Konrad ^{[1
,2
]}

Abdallah, Faraj W. ^{[3
,4
,5
,6
]}

Hussain, Mohamad A. ^{[1
,2
]}

de Mestral, Charles ^{[1
,2
]}

Greco, Elisa ^{[1
,2
]}

Aljabri, Badr ^{[1
,15
]}

Mamdani, Muhammad ^{[7
,8
,9
,10
,11
]}

Mazer, C. David ^{[3
,5
]}

Forbes, Thomas L. ^{[1
,12
,13
]}

Verma, Subodh ^{[1
,14
]}

Al-Omran, Mohammed ^{[1
,2
,15
]}

机构：

[1] Univ Toronto, Div Vasc Surg, Dept Surg, Toronto, ON, Canada

[2] St Michaels Hosp, Li Ka Shing Knowledge Inst, Div Vasc Surg, Toronto, ON, Canada

[3] Univ Toronto, Dept Anesthesiol & Pain Med, Toronto, ON, Canada

[4] Univ Ottawa, Dept Anaesthesia, Ottawa, ON, Canada

[5] St Michaels Hosp, Li Ka Shing Knowledge Inst, Dept Anaesthesia, Toronto, ON, Canada

[6] Ottawa Hosp Res Inst, Ottawa, ON, Canada

[7] St Michaels Hosp, Li Ka Shing Knowledge Inst, Li Ka Shing Ctr Healthcare Analyt Res & Training, Toronto, ON, Canada

[8] Univ Toronto, Leslie Dan Fac Pharm, Toronto, ON, Canada

[9] Univ Toronto, Dept Med, Fac Med, Toronto, ON, Canada

[10] Univ Toronto, Dalla Lana Fac Publ Hlth, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada

[11] Sunnybrook Med Ctr, Inst Clin Evaluat Sci, Toronto, ON, Canada

[12] Univ Hlth Network, Peter Munk Cardiac Ctr, Div Vasc Surg, Toronto, ON, Canada

[13] Univ Toronto, Toronto, ON, Canada

[14] St Michaels Hosp, Li Ka Shing Knowledge Inst, Div Cardiac Surg, Toronto, ON, Canada

[15] King Saud Univ, Dept Surg, Riyadh, Saudi Arabia

来源：

BRITISH JOURNAL OF ANAESTHESIA | 2020年 / 124卷 / 05期

基金：

加拿大健康研究院;

关键词：

abdominal aortic aneurysm; neuraxial anaesthesia; open aneurysm repair; population-based research; retrospective cohort; RISK; MORBIDITY; MORTALITY; SURVIVAL; BENEFITS; ONTARIO; STROKE;

D O I：

10.1016/j.bja.2020.01.018

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

Background: Use of neuraxial anaesthesia for open abdominal aortic aneurysm repair is postulated to reduce mortality and morbidity. This study aimed to determine the 90-day outcomes after elective open abdominal aortic aneurysm repair in patients receiving combined general and neuraxial anaesthesia vs general anaesthesia alone. Methods: A retrospective population-based cohort study was conducted from 2003 to 2016. All patients >= 40 yr old undergoing open abdominal aortic aneurysm repair were included. The propensity score was used to construct inverse probability of treatment weighted regression models to assess differences in 90-day outcomes. Results: A total of 10 447 elective open abdominal aortic aneurysm repairs were identified; 9003 (86%) patients received combined general and neuraxial anaesthesia and 1444 (14%) received general anaesthesia alone. Combined anaesthesia was associated with significantly lower hazards for all-cause mortality (hazard ratio [HR]=0.47; 95% confidence interval [CI], 0.37-0.61) and major adverse cardiovascular events (HR=0.72; 95% CI, 0.60-0.86). Combined patients were at lower odds for acute kidney injury (odds ratio [OR]=0.66; 95% CI, 0.49-0.89), respiratory failure (OR=0.41; 95% CI, 0.36-0.47), and limb complications (OR=0.30; 95% CI, 0.25-0.37), with higher odds of being discharged home (OR=1.32; 95% CI, 1.15-1.51). Combined anaesthesia was also associated with significant mechanical ventilation and ICU and hospital length of stay benefits. Conclusions: Combined general and neuraxial anaesthesia in elective open abdominal aortic aneurysm repair is associated with reduced 90-day mortality and morbidity. Neuraxial anaesthesia should be considered as a routine adjunct to general anaesthesia for elective open abdominal aortic aneurysm repair.

引用

页码：544 / 552

页数：9

共 35 条

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