Effects of inhalation versus total intravenous anaesthesia on long-term mortality in older patients after noncardiac surgery: a retrospective observational study

IF 9.1 1区医学 Q1 ANESTHESIOLOGY British journal of anaesthesia Pub Date : 2024-08-05 DOI:10.1016/j.bja.2024.07.008

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Abstract

Background

Whether the anaesthetic agent used influences postoperative mortality in older patients remains unclear. We evaluated the effect of total intravenous anaesthesia (TIVA) vs inhalation anaesthesia on long-term mortality in older patients after noncardiac surgery.

Methods

We retrospectively analysed 45,879 patients aged ≥60 yr who underwent noncardiac surgery under general anaesthesia (for ≥2 h) between January 2011 and June 2019. They were divided into two groups according to the type of maintenance anaesthetic. The primary outcome was all-cause mortality within 1 yr after surgery. Secondary outcomes included postoperative complications (postoperative pulmonary complications, perioperative adverse cardiovascular events, and acute kidney injury), and 3-yr and 5-yr mortality after surgery. The stabilised inverse probability of treatment weighting method was used to adjust for potential confounders.

Results

Among 45,879 patients, 7273 (15.9%) patients received TIVA and 38,606 (84.1%) patients received inhalation anaesthesia. After adjustment with inverse probability of treatment weighting, there was no association between the type of anaesthetic agent and 1-yr mortality (hazard ratio=0.95; 95% confidence interval [CI] 0.84−1.08). Results for 3-yr and 5-yr mortality were similar. However, inhalation anaesthesia was associated with increased risk of postoperative complications (odds ratio [OR]=1.30; 95% CI 1.22−1.37 for postoperative pulmonary complications, OR=1.34; 95% CI 1.22−1.48 for perioperative adverse cardiovascular events, and OR=2.19; 95% CI 1.88−2.57 for acute kidney injury). In the subgroup analysis, the choice of anaesthetic agent showed differential effects on 1-yr mortality for female patients and emergency surgery.

Conclusion

The choice of anaesthetic agent during the intraoperative period was not associated with 1-yr mortality in older patients undergoing noncardiac surgery.

Clinical trial registration

Clinical Research Information Service of the Republic of Korea (KCT 0006363).

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吸入麻醉与全静脉麻醉对非心脏手术后老年患者长期死亡率的影响：一项回顾性观察研究。

背景：使用的麻醉剂是否会影响老年患者的术后死亡率仍不清楚。我们评估了全静脉麻醉（TIVA）与吸入麻醉对老年非心脏手术患者长期死亡率的影响：我们回顾性分析了2011年1月至2019年6月期间在全身麻醉（≥2小时）下接受非心脏手术的45879名年龄≥60岁的患者。根据维持麻醉的类型将他们分为两组。主要结果是术后1年内的全因死亡率。次要结果包括术后并发症（术后肺部并发症、围手术期不良心血管事件和急性肾损伤）以及术后3年和5年的死亡率。采用稳定的逆概率治疗加权法来调整潜在的混杂因素：在45879名患者中，7273名（15.9%）患者接受了TIVA，38606名（84.1%）患者接受了吸入麻醉。经治疗概率反向加权调整后，麻醉剂类型与1年死亡率之间没有关联（危险比=0.95；95%置信区间[CI] 0.84-1.08）。3年和5年死亡率的结果相似。然而，吸入麻醉与术后并发症风险增加有关（术后肺部并发症的几率比 [OR]=1.30; 95% CI 1.22-1.37，围手术期不良心血管事件的几率比 OR=1.34; 95% CI 1.22-1.48，急性肾损伤的几率比 OR=2.19; 95% CI 1.88-2.57）。在亚组分析中，麻醉剂的选择对女性患者和急诊手术的1年死亡率有不同的影响：结论：在接受非心脏手术的老年患者中，术中麻醉剂的选择与1年死亡率无关：临床试验注册：大韩民国临床研究信息服务处（KCT 0006363）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

British journal of anaesthesia 医学-麻醉学

CiteScore

13.50

自引率

7.10%

发文量

488

审稿时长

27 days

期刊介绍： The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience. The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence. Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.