Risk of Cardiovascular Disease Due to General Anesthesia and Neuraxial Anesthesia in Lower-Limb Fracture Patients: A Retrospective Population-Based Cohort Study
Abstract
:1. Introduction
2. Experimental Section
2.1. Data Sources
2.2. Study Groups
2.3. Outcome and Covariate Measurement
2.4. Statistical Analysis
3. Results
3.1. Characteristics of Study Subjects
3.2. Risk of CVD with General Anesthesia, Neuraxial Anesthesia, Age, Gender, Different Comorbidities, and Other Conditions
3.3. Risk of CVD Between General Anesthesia and Neuraxial Anesthesia Patients and Specific Subgroup Characteristics
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
Neuraxial Anesthesia | General Anesthesia | |
---|---|---|
Follow-up duration (month, mean ± SD) | 11.6 ± 2 | 11.5 ± 2.0 |
Time to CVD (month, mean ± SD), N = 86 | 4.8 ± 3.6 | 6.0 ± 3.8 |
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Variables | General Anesthesia (N = 1504) | Neuraxial Anesthesia (N = 1933) | p-Value | ||
---|---|---|---|---|---|
N | % | N | % | ||
Age | <0.001 | ||||
<65 | 1080 | 71.8 | 1176 | 60.8 | |
≥65 | 424 | 28.2 | 757 | 39.2 | |
Mean ± SD | 50.7 ± 20.8 | 57.6 ± 20.8 | <0.001 | ||
Gender | 0.406 | ||||
Female | 720 | 47.9 | 953 | 49.3 | |
Male | 784 | 52.1 | 980 | 50.7 | |
Hypertension | 384 | 25.5 | 565 | 29.2 | 0.016 |
Hyperlipidemia | 107 | 7.1 | 200 | 10.3 | 0.001 |
Diabetes | 204 | 13.6 | 321 | 16.6 | 0.014 |
Renal disease | 39 | 2.6 | 56 | 2.9 | 0.590 |
Liver disease | 80 | 5.3 | 71 | 3.7 | 0.019 |
Chronic pulmonary disease | 88 | 5.9 | 153 | 7.9 | 0.019 |
Intensive care unit (ICU) admission | 127 | 8.4 | 44 | 2.3 | <0.001 |
Anticoagulants | 69 | 4.6 | 107 | 5.5 | 0.211 |
Anesthesia time | <0.001 | ||||
<2 h | 742 | 49.3 | 1377 | 71.2 | |
≥2 h | 762 | 50.7 | 556 | 28.8 | |
Hospital level | <0.001 | ||||
Medical centers | 553 | 36.8 | 480 | 24.8 | |
Regional hospitals | 725 | 48.2 | 826 | 42.7 | |
District hospitals | 180 | 12.0 | 599 | 31.0 | |
Clinics | 46 | 3.1 | 28 | 1.4 |
Variables | No. of CVD Events | Observed Person-Years | Incidence Density (Per 1000 Person-Years) | Crude HR | 95% CI | p-Value | Adjusted HR † | 95% CI | p-Value |
---|---|---|---|---|---|---|---|---|---|
Group | |||||||||
Neuraxial anesthesia | 48 | 1861 | 25.8 | 1 | 1 | ||||
General anesthesia | 38 | 1447 | 26.3 | 1.02 | 0.67–1.56 | 0.933 | 1.24 | 0.80–1.92 | 0.334 |
Age | |||||||||
<65 | 18 | 2221 | 8.1 | 1 | 1 | ||||
≥65 | 68 | 1087 | 62.6 | 7.67 | 4.56–12.90 | <0.001 | 5.77 | 3.21–10.38 | <0.001 |
Gender | |||||||||
Female | 43 | 1616 | 26.6 | 1 | 1 | ||||
Male | 43 | 1692 | 25.4 | 0.95 | 0.63–1.46 | 0.829 | 1.89 | 1.21–2.95 | 0.005 |
Hypertension | 52 | 886 | 58.7 | 4.16 | 2.70–6.42 | <0.001 | 1.63 | 0.98–2.70 | 0.059 |
Hyperlipidemia | 14 | 293 | 47.8 | 2.00 | 1.13–3.54 | 0.018 | 0.91 | 0.49–1.66 | 0.749 |
Diabetes | 35 | 485 | 72.2 | 3.97 | 2.58–6.11 | <0.001 | 2.09 | 1.29–3.37 | 0.003 |
Renal disease | 8 | 78 | 102.7 | 4.18 | 2.02–8.66 | <0.001 | 1.48 | 0.70–3.12 | 0.305 |
Liver disease | 3 | 142 | 21.1 | 0.80 | 0.25–2.54 | 0.707 | 0.58 | 0.18–1.84 | 0.354 |
Chronic pulmonary disease | 11 | 221 | 49.8 | 2.04 | 1.08–3.84 | 0.027 | 1.21 | 0.64–2.30 | 0.561 |
ICU admission | 11 | 142 | 77.3 | 3.22 | 1.71–6.06 | <0.001 | 2.59 | 1.35–4.96 | 0.004 |
Anticoagulants | 14 | 159 | 87.8 | 3.81 | 2.15–6.75 | <0.001 | 1.80 | 0.97–3.31 | 0.061 |
Variables | No. of CVD Events | Observed Person-Years | Incidence Density (Per 1000 Person-Years) | Crude HR | 95% CI | p-Value | Adjusted HR † | 95% CI | p-Value |
---|---|---|---|---|---|---|---|---|---|
Group | |||||||||
NA < 2 h | 32 | 1326 | 24.1 | 1 | 1 | ||||
NA ≥ 2 h | 16 | 535 | 29.9 | 1.24 | 0.68–2.26 | 0.482 | 1.00 | 0.55–1.83 | 0.999 |
GA < 2 h | 15 | 720 | 20.8 | 0.86 | 0.47–1.60 | 0.641 | 1.05 | 0.57–1.95 | 0.866 |
GA ≥ 2 h | 23 | 727 | 31.7 | 1.31 | 0.77–2.24 | 0.322 | 1.43 | 0.81–2.50 | 0.217 |
General Anesthesia | Neuraxial Anesthesia | HR | 95% CI | p-Value | |||
---|---|---|---|---|---|---|---|
N | No. of CVD Events | N | No. of CVD Event | ||||
Age † | |||||||
<65 | 1080 | 7 | 1176 | 11 | 0.60 | 0.21–1.66 | 0.323 |
≥65 | 424 | 31 | 757 | 37 | 1.49 | 0.92–2.43 | 0.107 |
sex ‡ | |||||||
Female | 720 | 22 | 953 | 21 | 1.68 | 0.92–3.07 | 0.093 |
Male | 784 | 16 | 980 | 27 | 0.84 | 0.43–1.66 | 0.619 |
N | No. of CVD Event | Adjusted HR † | 95% CI | p-Value | |
---|---|---|---|---|---|
Follow-up period ≤6 months | |||||
Group | |||||
Neuraxial anesthesia | 1933 | 28 | 1 | ||
General anesthesia | 1504 | 19 | 1.05 | 0.58–1.91 | 0.875 |
Follow-up period 7–12 months | |||||
Group | |||||
Neuraxial anesthesia | 1859 | 20 | 1 | ||
General anesthesia | 1444 | 19 | 1.52 | 0.79–2.91 | 0.206 |
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Yeh, H.-W.; Yeh, L.-T.; Chou, Y.-H.; Yang, S.-F.; Ho, S.-W.; Yeh, Y.-T.; Yeh, Y.-T.; Wang, Y.-H.; Chan, C.-H.; Yeh, C.-B. Risk of Cardiovascular Disease Due to General Anesthesia and Neuraxial Anesthesia in Lower-Limb Fracture Patients: A Retrospective Population-Based Cohort Study. Int. J. Environ. Res. Public Health 2020, 17, 33. https://doi.org/10.3390/ijerph17010033
Yeh H-W, Yeh L-T, Chou Y-H, Yang S-F, Ho S-W, Yeh Y-T, Yeh Y-T, Wang Y-H, Chan C-H, Yeh C-B. Risk of Cardiovascular Disease Due to General Anesthesia and Neuraxial Anesthesia in Lower-Limb Fracture Patients: A Retrospective Population-Based Cohort Study. International Journal of Environmental Research and Public Health. 2020; 17(1):33. https://doi.org/10.3390/ijerph17010033
Chicago/Turabian StyleYeh, Han-Wei, Liang-Tsai Yeh, Ying-Hsiang Chou, Shun-Fa Yang, Sai-Wai Ho, Ying-Tung Yeh, Ying-Ting Yeh, Yu-Hsun Wang, Chi-Ho Chan, and Chao-Bin Yeh. 2020. "Risk of Cardiovascular Disease Due to General Anesthesia and Neuraxial Anesthesia in Lower-Limb Fracture Patients: A Retrospective Population-Based Cohort Study" International Journal of Environmental Research and Public Health 17, no. 1: 33. https://doi.org/10.3390/ijerph17010033