Association of Neuraxial Anesthesia With Postoperative Venous Thromboembolism After Noncardiac Surgery
Autor: | Guangmei Mao, Daniel I. Sessler, Hesham Elsharkawy, Merve Yazici Kara, Thomas Botsford, Wael Ali Sakr Esa, Kamal Maheshwari, Gausan Ratna Bajracharya, Alparslan Turan, Steve Leung, Kurt Ruetzler |
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Rok vydání: | 2019 |
Předmět: |
Anesthesia
Epidural Male medicine.medical_specialty Databases Factual computer.software_genre Venous stasis 03 medical and health sciences Postoperative Complications 0302 clinical medicine 030202 anesthesiology medicine Humans Orthopedic Procedures Propensity Score Societies Medical Aged Retrospective Studies Database business.industry Incidence (epidemiology) Retrospective cohort study Venous Thromboembolism Odds ratio Middle Aged medicine.disease Quality Improvement Confidence interval Venous thrombosis Anesthesiology and Pain Medicine Anesthesia Propensity score matching Orthopedic surgery Female business computer 030217 neurology & neurosurgery |
Zdroj: | Anesthesia & Analgesia. 128:494-501 |
ISSN: | 0003-2999 |
Popis: | BACKGROUND Neuraxial anesthesia improves components of the Virchow's triad (hypercoagulability, venous stasis, and endothelial injury) which are key pathogenic contributors to venous thrombosis in surgical patients. However, whether neuraxial anesthesia reduces the incidence of venous thromboembolism (VTE) remain unclear. We therefore tested the primary hypothesis that neuraxial anesthesia reduces the incidence of 30-day VTE in adults recovering from orthopedic surgery. Secondarily, we tested the hypotheses that neuraxial anesthesia reduces 30-day readmission, 30-day mortality, and the duration of postoperative hospitalization. METHODS Inpatient orthopedic surgeries from American College of Surgeons National Surgical Quality Improvement Program database (2011-2015) in adults lasting more than 1 hour with either neuraxial or general anesthesia were included. Groups were matched 1:1 by propensity score matching for appropriate confounders. Logistic regression model was used to assess the effect of neuraxial anesthesia on 30-day VTE, 30-day mortality, and readmission, while Cox proportional hazard regression model was used to assess its effect on length of stay. RESULTS Neuraxial anesthesia decreased odds of 30-day VTE (odds ratio 0.85, 95% confidence interval, 0.78-0.95; P = .002) corresponding to number-needed-to-treat of 500. Although there was no difference in 30-day mortality, neuraxial anesthesia reduced 30-day readmission (odds ratio 0.90, 98.3% confidence interval, 0.85-0.95; P < .001) corresponding to number-needed-to-treat of 250 and had a shortened hospitalization (2.87 vs 3.11; P < .001). CONCLUSIONS Neuraxial anesthesia appears to provide only weak VTE prophylaxis, but can be offered as an adjuvant to current thromboprophylaxis in high-risk patients. |
Databáze: | OpenAIRE |
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