我们对当代RCT进行了系统评价和荟萃分析,以使用基于共识的核心结果集确定脊柱与全身麻醉(SA与GA)在髋部骨折手术患者中的临床有效性。以及由患者和公众参与(PPI)计划定义为重要的结果。
RCT比较任何核心结果(死亡率,从受伤到手术的时间,急性冠脉综合征,低血压,急性肾损伤,谵妄,肺炎,矫正输入,术后第1天下床,和疼痛)或PPI定义的结果(恢复到术前停留,生活质量,和移动性状态)从MEDLINE中识别出SA和GA之间的差异,Embase,科克伦图书馆,和WebofScience(2000年至2022年2月)。估计集合相对风险(RR)和平均差异(95%置信区间[CI])。
SA与GA相比,谵妄的风险没有显着差异(RR=1.07;95%CI,0.90-1.29)。比较SA与GA,住院期间死亡率为0.56(95%CI,0.22-1.44),30天1.07(95%CI,0.52-2.23),90天时为1.08(95%CI,0.55-2.12)。与GA相比,脊柱麻醉降低了急性肾损伤的风险:RR=0.59(95%CI,0.39-0.89)。其他结局的风险没有显着差异。很少有研究报告PPI定义的结果,大多数研究报告一到三个核心结果。
除了急性肾损伤,当使用基于共识的核心结局集以及患者和公众参与定义的结局时,SA和GA在髋部骨折手术中没有差异.大多数研究报告了来自核心结果集的有限结果,很少报告对患者重要的结果,在设计未来的RCT时应该考虑这一点。
CRD42021275206。
We conducted a systematic review and meta-analysis of contemporary RCTs to determine the clinical effectiveness of spinal vs general anaesthesia (SA vs GA) in patients undergoing hip fracture surgery using a
consensus-based core outcome set, and outcomes defined as important by patient and public involvement (PPI) initiatives.
RCTs comparing any of the core outcomes (mortality, time from injury to surgery, acute coronary syndrome, hypotension, acute kidney injury, delirium, pneumonia, orthogeriatric input, being out of bed at day 1 postoperatively, and pain) or PPI-defined outcomes (return to preoperative residence, quality of life, and mobility status) between SA and GA were identified from MEDLINE, Embase, Cochrane Library, and Web of Science (2000 to February 2022). Pooled relative risks (RRs) and mean differences (95% confidence intervals [CIs]) were estimated.
There was no significant difference in the risk of delirium comparing SA vs GA (RR=1.07; 95% CI, 0.90-1.29). Comparing SA vs GA, the RR for mortality was 0.56 (95% CI, 0.22-1.44) in-hospital, 1.07 (95% CI, 0.52-2.23) at 30 days, and 1.08 (95% CI, 0.55-2.12) at 90 days. Spinal anaesthesia reduced the risk of acute kidney injury compared with GA: RR=0.59 (95% CI, 0.39-0.89). There were no significant differences in the risk of other outcomes. Few studies reported PPI-defined outcomes, with most studies reporting on one to three core outcomes.
Except for acute kidney injury, there were no differences between SA and GA in hip fracture surgery when using a
consensus-based core outcome set and patient and public involvement-defined outcomes. Most studies reported limited outcomes from the core outcome set, and few reported outcomes important to patients, which should be considered when designing future RCTs.
CRD42021275206.