Anaesthetic care or patients undergoing primary hip and knee arthroplasty: consensus recommendations from the International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) based on a systematic review and meta-analysis

被引：213

作者：

Memtsoudis, Stavros G. ^{[1
,2
,3
]}

Cozowicz, Crispiana ^{[1
,2
,3
]}

Bekeris, Janis ^{[1
,2
,3
]}

Bekere, Dace ^{[1
,2
]}

Liu, Jiabin ^{[1
,2
]}

Soffin, Ellen M. ^{[1
,2
]}

Mariano, Edward R. ^{[4
]}

Johnson, Rebecca L. ^{[5
]}

Hargett, Mary J. ^{[1
,2
]}

Lee, Bradley H. ^{[1
,2
]}

Wendel, Pamela ^{[1
,2
]}

Brouillette, Mark ^{[1
,2
]}

Go, George ^{[1
,2
]}

Kim, Sang J. ^{[1
,2
]}

Baaklini, Lila ^{[1
,2
]}

Wetmore, Douglas ^{[1
,2
]}

Hong, Genewoo ^{[1
,2
]}

Goto, Rie ^{[6
]}

Jivanelli, Bridget ^{[6
]}

Argyra, Eriphyli ^{[7
]}

Barrington, Michael J. ^{[8
]}

Borgeat, Alain ^{[9
]}

De Andres, Jose ^{[10
,11
]}

Elkassabany, Nabil M. ^{[12
]}

Gautier, Philippe E. ^{[3
,13
]}

Gerner, Peter ^{[3
]}

Della Valle, Alejandro Gonzalez ^{[1
,2
]}

Goytizolo, Enrique ^{[1
,2
]}

Kessler, Paul ^{[14
]}

Kopp, Sandra L. ^{[5
]}

Homme, Patricia Lavand ' ^{[15
]}

MacLean, Catherine H. ^{[16
]}

Mantilla, Carlos B. ^{[5
]}

MacIsaac, Daniel ^{[17
]}

McLawhorn, Alexander ^{[18
]}

Neal, Joseph M. ^{[19
]}

Parks, Michael ^{[18
]}

Parvizi, Javad ^{[20
]}

Pichler, Lukas ^{[3
]}

Poeran, Jashvant ^{[21
]}

Poultsides, Lazaros A. ^{[22
]}

Sites, Brian D. ^{[23
]}

Stundner, Otto ^{[3
]}

Sun, Eric C. ^{[24
]}

Viscusi, Eugene R. ^{[25
]}

Votta-Velis, Effrossyni G. ^{[26
]}

Wu, Christopher L. ^{[1
,2
]}

Deau, Jacques T. Ya ^{[1
,2
]}

Sharrock, Nigel E. ^{[1
,2
]}

机构：

[1] Hosp Special Surg, Dept Anesthesiol Crit Care & Pain Management, 535 E 70th St, New York, NY 10021 USA

[2] Weill Cornell Med Coll, Dept Anesthesiol, New York, NY 10065 USA

[3] Paracelsus Med Univ, Dept Anesthesiol Perioperat Med & Intens Care Med, Salzburg, Austria

[4] Vet Affairs Palo Alto Hlth Care Syst, Dept Anesthesia, Palo Alto, CA USA

[5] Mayo Clin, Dept Anesthesiol & Perioperat Med, Rochester, MN USA

[6] Weill Cornell Med Coll, Hosp Special Surg, Kim Barrett Mem Lib, New York, NY USA

[7] Natl & Kapodistrian Univ Athens, Dept Anaesthesiol Pain & Palliat Care, Athens, Greece

[8] Univ Melbourne, Dept Med & Radiol, Melbourne, Vic, Australia

[9] Univ Zurich, Dept Anesthesiol & Intens Care Med, Zurich, Switzerland

[10] Univ Valencia, Med Sch, Anesthesia Unit, Surg Specialties Dept, Valencia, Spain

[11] Gen Univ Hosp, Anesthesia Crit Care & Pain Management Dept, Valencia, Spain

[12] Univ Penn, Dept Anesthesiol & Crit Care, Philadelphia, PA 19104 USA

[13] Clin Ste Anne St Remi, Dept Anesthesiol, Anderlecht, Belgium

[14] Orthoped Univ Hosp, Dept Anesthesiol Intens Care & Pain Med, Frankfurt, Germany

[15] Clin Univ St Luc, Dept Anesthesiol, Brussels, Belgium

[16] Weill Cornell Med Coll, Hosp Special Surg, Value Management Off, New York, NY USA

[17] Univ Ottawa, Dept Anesthesiol & Pain Med, Ottawa, ON, Canada

[18] Weill Cornell Med Coll, Hosp Special Surg, Dept Orthoped Surg Hip & Knee Replacement, New York, NY USA

[19] Virginia Mason Med Ctr, Dept Anesthesiol, Seattle, WA 98101 USA

[20] Rothman Orthopaed Inst, Bensalem, PA USA

[21] Icahn Sch Med Mt Sinai, Dept Populat Hlth Sci & Policy, Inst Healthcare Delivery Sci, New York, NY 10029 USA

[22] New York Langone Orthopaed Hosp, Dept Orthopaed Surg, New York, NY USA

[23] Dartmouth Coll, Geisel Sch Med, Dept Anesthesiol, Hanover, NH 03755 USA

[24] Stanford Univ, Dept Anesthesia, Sch Med, Stanford, CA 94305 USA

[25] Thomas Jefferson Univ, Sidney Kimmel Med Coll, Pain Ctr, Dept Anesthesiol, Philadelphia, PA 19107 USA

[26] Univ Illinois Hosp & Hlth Sci Syst, Dept Anesthesiol, Chicago, IL USA

来源：

BRITISH JOURNAL OF ANAESTHESIA | 2019年 / 123卷 / 03期

关键词：

anaesthesia; epidural; general; spinal; arthroplasty; replacement; hip; knee; assessment; outcomes; DEEP-VEIN THROMBOSIS; INTRAVENOUS GENERAL-ANESTHESIA; EPIDURAL-ANESTHESIA; BLOOD-LOSS; SPINAL-ANESTHESIA; REGIONAL ANESTHESIA; VENOUS THROMBOSIS; URINARY RETENTION; RISK-FACTORS; CONTROLLED ANALGESIA;

D O I：

10.1016/j.bja.2019.05.042

中图分类号：

R614 [麻醉学];

学科分类号：

100217 [麻醉学];

摘要：

Background is Evidence-based international expert consensus regarding anaesthetic practice in hip/knee arthroplasty surgery is needed for improved healthcare outcomes. Methods: The International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) systematic review, including randomised controlled and observational studies comparing neuraxial to general anaesthesia regarding major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, genitourinary, thromboembolic, neurological, infectious, and bleeding complications. Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, from 1946 to May 17, 2018 were queried. Meta-analysis and Grading of Recommendations Assessment, Development and Evaluation approach was utilised to assess evidence quality and to develop recommendations. Results: The analysis of 94 studies revealed that neuraxial anaesthesia was associated with lower odds or no difference in virtually all reported complications, except for urinary retention. Excerpt of complications for neuraxial vs general anaesthesia in hip/knee arthroplasty, respectively: mortality odds ratio (OR): 0.67, 95% confidence interval (CI): 0.57-0.80/ OR: 0.83, 95% CI: 0.60-1.15; pulmonary OR: 0.65, 95% CI: 0.52-0.80/OR: 0.69, 95% CI: 0.58-0.81; acute renal failure OR: 0.69, 95% CI: 0.59-0.81/OR: 0.73, 95% CI: 0.65-0.82; deep venous thrombosis OR: 0.52, 95% CI: 0.42-0.65/OR: 0.77, 95% CI: 0.64-0.93; infections OR: 0.73, 95% CI: 0.67-0.79/OR: 0.80, 95% CI: 0.76-0.85; and blood transfusion OR: 0.85, 95% CI: 0.82-0.89/OR: 0.84, 95% CI: 0.82-0.87. Conclusions: Recommendation: primary neuraxial anaesthesia is preferred for knee arthroplasty, given several positive postoperative outcome benefits; evidence level: low, weak recommendation. Recommendation: neuraxial anaesthesia is recommended for hip arthroplasty given associated outcome benefits; evidence level: moderate-low, strong recommendation. Based on current evidence, the consensus group recommends neuraxial over general anaesthesia for hip/knee arthroplasty.

引用

页码：269 / 287

页数：19

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