Chia Nan University of Pharmacy & Science Institutional Repository:Item 310902800/29645
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    標題: Propensity Score-matched Comparison of Postoperative Adverse Outcomes between Geriatric Patients Given a General or a Neuraxial Anesthetic for Hip Surgery A Population-based Study
    作者: Chu, Chin-Chen
    Weng, Shih-Feng
    Chen, Kuan-Ting
    Chien, Chih-Chiang
    Shieh, Ja-Ping
    Chen, Jen-Yin
    Wang, Jhi-Joung
    貢獻者: 老人服務事業管理系
    關鍵字: Patent foramen ovale
    Fracture surgery
    Regional anesthesia
    Comorbidity index
    Economic burden
    日期: 2015-07
    上傳時間: 2016-04-19 19:03:09 (UTC+8)
    出版者: Lippincott Williams & Wilkins
    摘要: Background: The effects of the mode of anesthesia on major adverse postoperative outcomes in geriatric patients are still inconclusive. The authors hypothesized that a neuraxial anesthetic (NA) rather than a general anesthetic (GA) would yield better in-hospital postoperative outcomes for geriatric patients undergoing hip surgery.Methods: The authors used data from Taiwan's 1997-2011 in-patient claims database to evaluate the effect of anesthesia on in-hospital outcomes. The endpoints were mortality, stroke, transient ischemic stroke, myocardial infarction, respiratory failure, and renal failure. Of the 182,307 geriatric patients who had hip surgery, a GA was given to 53,425 (29.30%) and an NA to 128,882 (70.70%). To adjust for baseline differences and selection bias, patients were matched on propensity scores, which left 52,044 GA and 52,044 NA patients.Results: GA-group patients had a greater percentage and higher odds of adverse in-hospital outcomes than did NA-group patients: death (2.62 vs. 2.13%; odds ratio [OR], 1.24; 95% CI, 1.15 to 1.35; P < 0.001), stroke (1.61 vs. 1.38%; OR, 1.18, 95% CI, 1.07 to 1.31; P = 0.001), respiratory failure (1.67 vs. 0.63%; OR, 2.71; 95% CI, 2.38 to 3.01; P < 0.001), and intensive care unit admission (11.03 vs. 6.16%; OR, 1.95; 95% CI, 1.87 to 2.05; P < 0.001), analyzed using conditional logistic regression. Moreover, patients given a GA had longer hospital stays (10.77 8.23 vs. 10.44 +/- 6.67 days; 95% CI, 0.22 to 0.40; P < 0.001) and higher costs (New Taiwan Dollars [NT$] 86,606 +/- NT$74,162 vs. NT$74,494 +/- NT$45,264; 95% CI, 11,366 to 12,859; P < 0.001).Conclusion: For geriatric patients undergoing hip surgery, NA was associated with fewer odds of adverse outcomes than GA.
    顯示於類別:[休閒保健管理系(所)] 期刊論文
    [醫務管理系(所)] 期刊論文
    [老人服務事業管理系] 期刊論文


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