Effects of anesthesia mode on the perioperative period and postoperative outcome in patients with traumatic fractures
10.11855/j.issn.0577-7402.2020.04.12
- Author:
Ling-Chao MENG
1
Author Information
1. Postgraduate Training Center, Fourth Medical Center of PLA General Hospital of Jinzhou Medical University
- Publication Type:Journal Article
- Keywords:
Fragility fracture;
General anesthesia;
Hip fracture;
Peripheral nerve block
- From:
Medical Journal of Chinese People's Liberation Army
2020;45(4):416-422
- CountryChina
- Language:Chinese
-
Abstract:
Objective To retrospectively analyze the effects of anesthesia mode on the perioperative period and postoperative outcome in patients with traumatic fractures. Methods A total of 699 patients with traumatic shoulder fractures and hip fractures, admitted in the Fourth Medical Center of PLA General Hospital from Mar. 2016 to Aug. 2018, were divided into general anesthesia (GA) group (n=331) and regional block anesthesia (RA) group (n=368) according to different anesthesia mode. The preoperative basic conditions, change rates of intra-operative mean arterial pressure (MAP) and heart rate (HR), amount of blood loss and transfusion, and postoperative outcome were recorded for analyzing whether different anesthesia methods affected the outcome of fracture patients in the real world. Results There was no significant difference in the preoperative comorbidity between the two groups (P>0.05); Compared with the GA group, patients in RA group were older (P<0.05). The surgical procedures were mostly closed reduction and internal fixation (P<0.05). The intra-operative MAP change rate was similar in the two groups (P=0.342); however, the MAP of patients in GA group returned to the level that the patient entered the operative room, while of patients in RA group was still lower, showing statistically significant between the two groups (P<0.001); the intra-operative amount of blood loss and transfusion in GA group was more than those in RA group, showing statistical difference (P=0.000). There was no significant difference between the two groups in postoperative intensive care unit (ICU) rate, total complication and fatality rate (P>0.05), but age analysis indicated that, regardless of the mode of anesthesia, the incidence of postoperative complications increases with age (P<0.05). Compared with GA, patients older than 80 years reduced the incidence of postoperative complications significantly when they chose RA, and the difference was statistically significant (P=0.039). Meanwhile, compared with GA group, patients in RA group was lower and shorter in preoperative time, operative time, length of stay and cost in hospital, showing statistical difference (P<0.05). Conclusions Although there was no significant difference in postoperative outcomes of patients with overall fractures under different anesthesia modes, postoperative complications will increase with age. The advantages of regional block anesthesia are mainly reflected in fracture patients ≥80 years.
