Comparing outcomes after peripheral nerve block versus general anesthesia for lower extremity amputation: a nationwide exploratory retrospective cohort study in Japan

• Published in: Regional anesthesia and pain medicine Vol. 45; no. 6; pp. 399 - 404
• Main Authors: Abe, Hiroaki, Sumitani, Masahiko, Matsui, Hiroki, Aso, Shotaro, Inoue, Reo, Fushimi, Kiyohide, Uchida, Kanji, Yasunaga, Hideo, Yamada, Yoshitsugu
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.06.2020; Copyright by American Society of Regional Anesthesia and Pain Medicine; BMJ Publishing Group LTD
• Subjects: Acute coronary syndromes; Age; Amputation; Anticoagulants; Body mass index; Cardiovascular disease; Codes; Cohort analysis; Delirium; Dementia; Epidural; Gangrene; General anesthesia; Heart; Hospitalization; Hospitals; Intubation; Kidney diseases; lower extremity; Lung diseases; Morbidity; Mortality; Original research; Pain; Patients; postoperative pain; Postoperative period; Regional anesthesia; Sepsis; Stroke; Surgery; surgical outcome; Ventilators; Japan; surgical outcome; postoperative pain; lower extremity
• ISSN: 1098-7339; 1532-8651
• DOI: 10.1136/rapm-2019-101208

Background and objectivesThe health benefits of peripheral nerve block (PNB) on postoperative complications after lower extremity amputation (LEA) compared with general anesthesia (GA) remains controversial. We performed a retrospective propensity score-matched cohort analysis to compare major outcomes after LEA with PNB versus GA.Materials and methodsWe used a nationwide inpatient database in Japan to compare patient outcomes after LEA with PNB versus GA from 2010 to 2016. Our primary outcome was 30-day mortality after LEA. The incidence of composite morbidity from life-threatening complications and of delirium within 30 days after LEA were secondary outcomes. We conducted propensity score-matched analyses of patients who underwent below knee or foot amputation using 36 covariates. Logistic regression analyses fitted with generalized estimating equations were performed to calculate ORs and their 95% CIs.ResultsOf 11 796 patients, 747 received PNB and 11 049 received GA. After one-to-four propensity score matching, 747 patients were included in the PNB group and 2988 in the GA group. The adjusted ORs for postoperative mortality, composite morbidity and delirium within 30 days after LEA were 1.11 (95% CI 0.75 to 1.64), 1.15 (95% CI 0.85 t o1.56) and 0.75 (95% CI 0.57 to 0.98), respectively, for the PNB group with reference to the GA group.ConclusionsThere was no significant difference between groups in 30-day mortality or composite morbidity. The PNB group showed a significantly lower risk of postoperative delirium than the GA group. Our findings suggest that PNB may have advantages over GA in preventing postoperative delirium among patients undergoing LEA.