Retrospective Analysis Of Perioperative Risk Factors Related To Anesthesia On Postoperative Pulmonary Complications In Elderly Patients Who Had Undergone Total Hip Arthroplasty

Background Factors related to anesthesia such as professional level of anesthesiologists,surgical position of patients,duration or type of anesthesia and type or dose of anesthetic drugs during the anesthesia procedure may be the risk factors of postoperative pulmonary complications(PPCs)for elderly patients who had undergone total hip arthroplasty(THA).Clinical studies in recent years have been confirmed that PPCs remain to be the most common complications discovered in some conventional surgery such as abdominal,cardiothoracic and orthopaedic surgery,including pulmonary embolism,pneumonia,bronchitis,bronchospasm,acute respiratory distress syndrome(ARDS),atelectasis and even respiratory failure etc.PPCs persistently and continuously remain to be one of the important factors in increasing morbidity and mortality,admission rate of intensive care unit(ICU),patients economic burden and prolonging length of hospital stay(LOS).Decreasing the incidence of PPCs can effectively reduce the morbidity and mortality,the admission rate of ICU,lower the patients economic burden,shorten LOS and improve the prognosis of patients and the quality of patients lives.THA is always the effective way to treat diseases of hip joint lesion with obviously relieving the hip joint pain and keeping the joint active and stable.The risks of complications especially in elderly patients who had undergone THA will be greatly increased due to the basic diseases such as chronic obstructive pulmonary disease(COPD),diabetes and hypertension they had and the lower immunity,hypoxia-tolerance and compensatory ability.The incidence of PPCs and risk factors related to anesthesia in elderly patients who had undergone THA are rarely reported in recent years.Risk factors associated with anesthesia,such as the level of the anesthesiologist(title),anesthesia time,type of anesthesia,kind and dose of anesthetic,can lead to PPCs in elderly patients who underwent total hip arthroplasty.Objective The aim of the study was to recognize and identify risk factors related to anesthesia for PPCs in elderly patients who had undergone total hip arthroplasty by using a retrospective analysis.We strongly believe that this study will provide plenty of clinical evidence and effective interventive measurements to reduce the incidence of PPCs.Methods(1)Retrospective Analysis of Perioperative Risk Factors Related to Anesthesia on Postoperative Pulmonary Complications in Elderly Patients Who Had Undergone THA:The medical records and clinical data of 324 patients who underwent THA surgery were reviewed and extracted.Those data included sex,age,body mass index(BMI),Charlson comorbidities index(CCI)grading,American Society of Aneshesiologists(ASA)grading,operative position,title of anesthesiologists,type of anesthesia,ways of invasive manipulation,central venous pressure(CVP)monitor,dose of opioid and dexmedetomidine,blood gas analysis in anesthesia,blood transfusion in anesthesia,intraoperative transfusion volume and crystalloid/colloid ratio,duration of anesthesia and operation,LOS and postoperative analgesia.The incidence of PPCs was calculated and the significant factors were identified by Chi-Square Test or Fisher exact test if necessary.Binary logistic regression models were developed to determine the effects of the potential risk factors that have a significant association with PPCs by using the forward procedure.(2)Retrospective Analysis of Perioperative Risk Factors Related to Anesthesia on Postoperative Pulmonary Complications in Elderly Patients Who Had Undergone THA under general anesthesia:The medical records and clinical data of 280 patients who underwent THA were reviewed and extracted.Those data included sex,age,Body mass index(BMI),preoperative hypoproteinemia,Charlson comorbidities index(CCI)grading,ASA classification,title of anesthesiologists,dose of opioid and dexmedetomidine,type and dose of muscle relaxant,use of sevoflurane,intraoperative transfusion volume and crystalloid/colloid ratio and blood gas analysis in anesthesia,duration of anesthesia and operation,LOS and postoperative analgesia,The incidence of PPCs was calculated and the significant factors were identified by Chi-Square Test or Fisher exact test if necessary.Binary logistic regression models were developed to determine the effects of the potential risk factors that have a significant association with PPCs by using the forward procedure.Results(1)Results showed that a total of 324 postoperative elderly patients who had undergone THA were studied based on the strict inclusion and exclusion criteria.The average age was 73.6 ±7.7 years(ranging from 60 to 92)with 68.5%(n=222)being male and the incidence of PPCs was 10.8%(35 patients).Patients of more than 70 year old,with preoperative hypoproteinemia,CCI grading points more than 2 points,ASA classification more than grade Ⅱ,resident or attending physician,perianesthesia underwent blood-gas analysis,crystalloid/colloid ratio more than 1.8,anesthesia time less than 4h,surgical time less than 2h,LOS more than 11 days and patients without postoperative analgesia were identified to be significantly different,which were likely to be potential risk factors related to anesthesia.But only ASA classification more than grade Ⅱ was the independent risk of developing PPCs(OR:1.85;95%CI:1.53-2.18;P<0.05)based on the result of binary forward logistic regression analysis.(2)Results showed that a total of 280 postoperative elderly patients who had undergone total hip arthroplasty under general anesthesia were studied based on the strict inclusion and exclusion criteria.The incidence of PPCs was 11.7%(33 patients).Ten factors including age of more than 70 years,patients with preoperative hypoproteinemia,CCI grading point more than 2 points,ASA classification more than grade Ⅱ,resident or attending physician,using sevoflurane,transfusion volume more than 1400 ml,anesthsic time more than 4 hours,LOS more than 11 days and patients without postoperative analgesia were also identified to be potential risk factors.But only CCI grading point more than 2 points was the independent risk of developing PPCs(OR:1.79;95%Cl:1.62-2.01;P<0.05)based on the result of binary forward logistic regression analysis.Conclusion In summary,so many risks related to anesthesia were found on PPCs in elderly patients who had undergone total hip arthroplasty.And ASA classification more than grade Ⅱ was the independent risk of developing PPCs in elderly patients who had undergone THA,meanwhhile CCI grading point more than 2 points was the independent risk of developing PPCs in those who received general anesthesia.