医学
髋部骨折
谵妄
入射(几何)
全身麻醉
重症监护室
倾向得分匹配
美国麻醉师学会
麻醉
外科
骨质疏松症
内科学
重症监护医学
光学
物理
作者
Eun Jin Ahn,Hyo Jin Kim,Kyung Woo Kim,Hee Eun Choi,Hyun Kang,Si Ra Bang
出处
期刊:BMJ Open
[BMJ]
日期:2019-09-01
卷期号:9 (9): e029245-e029245
被引量:71
标识
DOI:10.1136/bmjopen-2019-029245
摘要
Objective To evaluate the effects of anaesthesia on postoperative outcome in elderly patients who underwent hip fracture surgery. Setting Nationwide National Health Insurance Sharing Service database of Korea. Participants All patients aged ≥65 years old who underwent hip fracture surgery, covered by the Korean National Health Insurance, between 1 January 2009 and 31 December 2015. Interventions Hip fracture surgery under general anaesthesia (group GA) or regional anaesthesia (group RA), with a principal diagnosis of femoral fracture. Primary and secondary outcome measures The primary outcome was the anaesthetic-type effect on 30-day mortality and the secondary outcome was postoperative delirium requiring pharmacological intervention. Results Among the 96 289 patients who underwent hip fracture surgery, 25 593 and 70 696 patients received GA and RA, respectively. After propensity score matching, 25 593 remained in each group. Postmatching mortality was lower in the RA than in the GA group (574 (2.24%) vs 654 (2.55%), p=0·0047, 95% CI −0.0099 to 0.0159). Delirium incidence was lower in the RA than in the GA group (5187 (20.27%) vs 5828 (22.77%), p<0·0001, 95% CI 0.019 to 0.045). The incidence of intensive care unit stay and ventilator care was lower in the RA than in the GA group (5838 (22.1%) vs 8055 (31.47%), p<0·0001, 95% CI 0.046 to 0.070 and 459 (1.73%) vs 1207 (4.72%), p<0·0001, 95% CI −0.0024 to 0.023, respectively). Conclusion RA was associated with better outcomes than GA, in terms of mortality, delirium, intensive care unit admission and ventilator care, in elderly patients who underwent hip fracture surgery.
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