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Panel issues exercise recommendations for people with osteoporosis and spine fractures
Comparative outcomes of peripheral nerve blocks versus general anesthesia for hip fractures in geriatric Chinese patients
http://www.ncbi.nlm.nih.gov/pubmed/24855341?dopt=Abstract
Patient Prefer Adherence. 2014 May 7;8:651-9. doi: 10.2147/PPA.S61903. eCollection 2014.
Comparative outcomes of peripheral nerve blocks versus general anesthesia for hip fractures in geriatric Chinese patients.
abstracto
ANTECEDENTES:
Los pacientes geriátricos sometidos a hemiartroplastia para las fracturas de cadera tienen una inaceptable alta tasa de complicaciones postoperatorias y la mortalidad. Si el tipo de anestesia puede afectar los resultados aún no han sido concluyentes .
OBJETIVOS:
Se comparó la anestesia general ( GA ) y los bloqueos nerviosos periféricos ( BNP ) en las complicaciones postoperatorias y la mortalidad en pacientes ancianos con fracturas de cuello femoral ( FNF ) sometidos a hemiartroplastia .
MATERIALES Y MÉTODOS:
Estudio retrospectivo de recogida de datos a partir de una base de datos electrónica . Doscientos diecisiete pacientes fueron sometidos a hemiartroplastia para FNF entre enero de 2008 y diciembre de 2012 en el Hospital General del Ejército de Liberación del Pueblo Chino . Se recogieron y analizaron datos sobre la mortalidad en el hospital dentro de 30 días , y de 1 año , las complicaciones , las comorbilidades , la pérdida de sangre y la transfusión , tiempo operatorio , la duración de la estancia hospitalaria postoperatoria , unidad de cuidados intensivos , y la carga de hospital. Los análisis de regresión de Cox univariante y multivariante de todas las variables se utilizaron para 30 días y la mortalidad a 1 año .
RESULTADOS:
Setenta y dos pacientes que recibieron GA y 145 que reciben los BNP fueron presentados y analizados con el tiempo . La mortalidad fue del 6,9 % , 14,7 % y 23,5 % en en el hospital , 30 días y 1 año , respectivamente después de la operación , mientras que la mortalidad y las complicaciones cardiovasculares no fue diferente entre las dos técnicas anestésicas. Comorbilidades preoperatorias y parámetros intraoperatorios no fueron estadísticamente diferentes , excepto que los pacientes que recibieron GA eran más propensas a tener demencia ( χ ( 2 ) = 10.45 , P = 0,001 ) . Las complicaciones más frecuentes fueron los eventos cardiovasculares agudos , trastornos electrolíticos y delirio. Eventos respiratorias agudas postoperatorias y la hipoxemia ambos también fueron comunes , pero no se encontraron diferencias entre los grupos ( χ ( 2 ) = 0,68 , p = 0,410 ; χ ( 2 ) = 3,42 , P = 0,065 , respectivamente). Los factores clave que influyen negativamente en la mortalidad fueron: edad , sexo masculino, la Sociedad Americana de Anestesiólogos de estado , la demencia , los eventos cardiovasculares perioperatorias y eventos respiratorios , derrame cerebral postoperatoria, infarto de miocardio, y la hipoxia .
CONCLUSIÓN :
La mortalidad y las complicaciones postoperatorias no son estadísticamente significativamente diferente entre BNP y GA en los pacientes sometidos a hemiartroplastia para eldery FNF .
PALABRAS CLAVE:
ancianos ; fracturas del cuello femoral ; la mortalidad ; complicaciones postoperatorias
Abstract
BACKGROUND:
Geriatric patients undergoing hemiarthroplasty for hip fractures have unacceptably high rates of postoperative complications and mortality. Whether anesthesia type can affect the outcomes has still been inconclusive.
OBJECTIVES:
We compared general anesthesia (GA) and peripheral nerve blocks (PNBs) on postoperative complications and mortality in elderly patients with femoral neck fractures (FNF) undergoing hemiarthroplasty.
MATERIALS AND METHODS:
This retrospective study involved data collection from an electronic database. Two hundred and seventeen patients underwent hemiarthroplasty for FNF between January 2008 and December 2012 at the Chinese People's Liberation Army General Hospital. Data on mortality within in-hospital, 30-day, and 1-year, complications, comorbidities, blood loss and transfusion, operative time, postoperative hospital length of stay, intensive care unit admission, and hospital charge were collected and analyzed. Univariate and multivariate Cox regression analyses of all variables were used for 30-day and 1-year mortality.
RESULTS:
Seventy-two patients receiving GA and 145 receiving PNBs were eventually submitted and analyzed. Mortality was 6.9%, 14.7%, and 23.5% at in-hospital, 30-day, and 1-year, respectively postoperatively, while mortality and cardiovascular complications did not differ between the two anesthetic techniques. Preoperative comorbidities and intraoperative parameters were not statistically different except that patients receiving GA were more likely to have dementia (χ (2)=10.45, P=0.001). The most common complications were acute cardiovascular events, electrolyte disturbances, and delirium. Postoperative acute respiratory events and hypoxemia both were also common, but no differences were found between groups (χ (2)=0.68, P=0.410; χ (2)=3.42, P=0.065, respectively). Key factors negatively influencing mortality included: age, male gender, American Society of Anesthesiologists status, dementia, perioperative cardiovascular events and respiratory events, postoperative stroke, myocardial infarction, and hypoxia.
CONCLUSION:
Mortality and postoperative complications are not statistically significantly different between PNBs and GA among eldery patients undergoing hemiarthroplasty for FNF.
KEYWORDS:
elderly; femoral neck fractures; mortality; postoperative complications
- PMID:
- 24855341
- [PubMed]
- PMCID:
- PMC4019620
miércoles, 21 de mayo de 2014
The Journal of Bone & Joint Surgery
The May 21st , 2014 version of The Journal of Bone & Joint Surgery is now available: http://bit.jbjs.org/1gQ1t7U
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Anterior Longitudinal Decompression in the Management of Severe Ossification of the Posterior Longitudinal Ligament in the Cervical Spine
http://www.healio.com/orthopedics/journals/ortho/%7B0865998a-c494-476c-ba1e-21fc21393b29%7D/anterior-longitudinal-decompression-in-the-management-of-severe-ossification-of-the-posterior-longitudinal-ligament-in-the-cervical-spine
FEATURE ARTICLE
Anterior Longitudinal Decompression in the Management of Severe Ossification of the Posterior Longitudinal Ligament in the Cervical Spine
Abstract
The advantages of anterior surgery for severe ossification of the posterior longitudinal ligament in the cervical spine have been reported. However, it is more technically demanding and associated with a high risk of surgery-related complications. The purpose of this study was to evaluate the feasibility of longitudinal decompression techniques in anterior surgery for severe ossification of the posterior longitudinal ligament in the cervical spine. Between June 2008 and December 2011, twenty-two patients (16 men and 6 women; average age, 58 years [range, 45–72 years]) who underwent anterior corpectomy and fusion for severe ossification of the posterior longitudinal ligament were studied retrospectively. The clinical efficacy, canal narrowing ratio, fused segment height, and complications were investigated. After a mean 25.4-month follow-up, mean Japanese Orthopaedic Association score increased from 8.8±1.4 preoperatively to 14.0±1.2 at final follow-up (P<.05), an improvement rate of 63.5%±12.5%. Mean canal narrowing ratio decreased from 62.0%±6.0% preoperatively to 8.2%±4.9% postoperatively (P<.05). Mean fused segment height increased 2.3±0.5 mm from pre- to postoperatively and decreased 2.8±0.4 mm from postoperatively to final follow-up (P>.05). Five patients developed cerebrospinal fluid leakage, and 1 patient experienced hematoma. No instrument failure was observed, and all patients had successful fusion. Anterior longitudinal decompression is a relatively effective procedure in the management of severe ossification of the posterior longitudinal ligament in the cervical spine. It can be applied to treat closed-base ossification of the posterior longitudinal ligament (defined as no space between the lateral margin of the ossified base and the spinal canal lateral wall), but it is associated with a high risk of cerebrospinal fluid leakage.
The authors are from the Department of Spine Surgery, Third Hospital of HeBei Medical University, Shijiazhuang, China.
The authors have no relevant financial relationships to disclose.
The authors thank Dr Liu Fajing, Department of Orthopaedic Surgery, HanDan Central Hospital, for the valuable suggestions and assistance with statistical analysis.
Correspondence should be addressed to: Yong Shen, MD, Department of Spine Surgery, Third Hospital of HeBei Medical University, 139 Ziqiang Rd, Shijiazhuang 050051, China ( shenyongspine2012@126.com).
Received: September 04, 2013
Accepted: November 08, 2013
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