Comparing the effects of peripheral nerve block and general anesthesia with general anesthesia alone on postoperative delirium and complications in elderly patients: a retrospective cohort study using a nationwide database. Issue 9 (30th May 2022)

• Record Type: Journal Article
• Authors: Yoshimura, Manabu; Shiramoto, Hiroko; Koga, Mami; Yoshimatsu, Aya; Morimoto, Yasuhiro
• Is Part Of: Regional anesthesia and pain medicine. Volume 47:Issue 9(2022)
• Page Start: 521
• Page End: 526
• Publication Date: 2022-05-30
• Subjects: OUTCOMES -- REGIONAL ANESTHESIA -- Pain, Postoperative; Conduction anesthesia -- Periodicals; Pain medicine -- Periodicals; 617.964
• DOI: 10.1136/rapm-2022-103566
• Languages: English
• ISSNs: 1098-7339

Abstract

Abstract : Introduction: The difference between the effects of peripheral nerve block (PNB) with general anesthesia (GA) and GA alone on the patients' postoperative clinical outcomes remains unknown. We assessed whether there is a difference in postoperative delirium and composite morbidity between patients receiving GA with PNB and GA alone using a national clinical database in Japan. Methods: We compared the outcomes of patients receiving GA with PNB and GA alone from April 2016 to October 2019. The primary outcome was postoperative delirium, defined as a status requiring newly prescribed antipsychotic drugs or that given the code of a reimbursable disease after the surgery date. The secondary outcome was morbidity incidence as the occurrence of at least one of any of the following life-threatening complications. We conducted propensity score-matched analyses using covariates for patients who underwent any surgical procedure. We used instrumental variables and restricted the definition of postoperative delirium and subgroup for sensitivity analyses. Results: Of 653, 759 patients, 90, 358 received GA-PNB and 563, 401 received only GA. After 1:4 propensity score matching, 89, 754 patients were included in the GA-PNB and 359, 015 in the GA. The adjusted ORs for postoperative delirium and composite morbidity were 0.96 (95% CIs 0.94 to 0.99; p<0.01), 0.80 (95% CIs 0.76 to 0.83; p<0.001), respectively, for the GA-PNB concerning the GA. For sensitivity analyses, findings were also consistent with instrumental variables and subgroup analyses. Discussion: This retrospective, nationwide cohort study demonstrated that GA-PNB was associated with a small reduction in the likelihood of postoperative delirium and a moderate reduction in the likelihood of composite morbidity.