BACKGROUND Use of neuraxial anaesthesia for open abdominal aortic aneurysm repair is postulated to reduce mortality and morbidity. This study aimed to determine the 90-day outcomes after elective open abdominal aortic aneurysm repair in patients receiving combined general and neuraxial anaesthesia vs general anaesthesia alone. METHODS A retrospective population-based cohort study was conducted from 2003 to 2016. All patients ≥40 yr old undergoing open abdominal aortic aneurysm repair were included. The propensity score was used to construct inverse probability of treatment weighted regression models to assess differences in 90-day outcomes. RESULTS A total of 10 447 elective open abdominal aortic aneurysm repairs were identified; 9003 (86%) patients received combined general and neuraxial anaesthesia and 1444 (14%) received general anaesthesia alone. Combined anaesthesia was associated with significantly lower hazards for all-cause mortality (hazard ratio [HR]=0.47; 95% confidence interval [CI], 0.37-0.61) and major adverse cardiovascular events (HR=0.72; 95% CI, 0.60-0.86). Combined patients were at lower odds for acute kidney injury (odds ratio [OR]=0.66; 95% CI, 0.49-0.89), respiratory failure (OR=0.41; 95% CI, 0.36-0.47), and limb complications (OR=0.30; 95% CI, 0.25-0.37), with higher odds of being discharged home (OR=1.32; 95% CI, 1.15-1.51). Combined anaesthesia was also associated with significant mechanical ventilation and ICU and hospital length of stay benefits. CONCLUSIONS Combined general and neuraxial anaesthesia in elective open abdominal aortic aneurysm repair is associated with reduced 90-day mortality and morbidity. Neuraxial anaesthesia should be considered as a routine adjunct to general anaesthesia for elective open abdominal aortic aneurysm repair.

中文翻译：

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选择性全开腹腹主动脉瘤修补术联合全麻和全麻联合全麻的短期结果：基于人群的回顾性队列研究†。

背景技术假定将神经麻醉用于开腹腹主动脉瘤修复以降低死亡率和发病率。这项研究的目的是确定接受全身麻醉和神经轴麻麻联合单纯麻醉的选择性开放性腹主动脉瘤修复术后90天的预后。方法2003年至2016年进行了一项基于人群的回顾性队列研究。所有年龄≥40岁的患者均接受开放性腹主动脉瘤修复。倾向得分用于构建治疗加权回归模型的逆概率，以评估90天结果的差异。结果共鉴定出10 447例选择性开放性腹主动脉瘤修补术。9003名（86％）患者接受了全身和神经联合麻醉，而1444名（14％）患者仅接受了全麻。联合麻醉与全因死亡率的危险性显着降低（危险比[HR] = 0.47； 95％置信区间[CI]，0.37-0.61）和重大心血管不良事件（HR = 0.72； 95％CI，0.60- 0.86）。合并患者发生急性肾损伤（几率[OR] = 0.66； 95％CI，0.49-0.89），呼吸衰竭（OR = 0.41； 95％CI，0.36-0.47）和肢体并发症（OR = 0.30； 95％CI，0.25-0.37），出院率更高（OR = 1.32； 95％CI，1.15-1.51）。组合麻醉还与明显的机械通气，ICU和住院时间长短有关。结论选择性全腹开放腹主动脉瘤修复术中全身麻醉和神经麻醉相结合可降低90天病死率和发病率。对于选择性开放性腹主动脉瘤修补术，应将神经外科麻醉作为全身麻醉的常规辅助措施。