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

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Original research
Comparing outcomes after peripheral nerve block versus general anesthesia for lower extremity amputation: a nationwide exploratory retrospective cohort study in Japan
  1. Hiroaki Abe1,
  2. Masahiko Sumitani1,
  3. Hiroki Matsui2,
  4. Shotaro Aso2,
  5. Reo Inoue3,
  6. Kiyohide Fushimi4,
  7. Kanji Uchida3,
  8. Hideo Yasunaga2 and
  9. Yoshitsugu Yamada5
  1. 1 Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
  2. 2 Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
  3. 3 Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
  4. 4 Department of Health Policy and Informatics, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
  5. 5 Department of Anesthesia, International University of Health and Welfare Mita Hospital, Minata-ku, Tokyo, Japan
  1. Correspondence to Dr Masahiko Sumitani, Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Bunkyo-ku 113-8655, Japan; SUMITANIM-ANE{at}h.u-tokyo.ac.jp

Abstract

Background and objectives The 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 methods We 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.

Results Of 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.

Conclusions There 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.

  • lower extremity
  • surgical outcome
  • postoperative pain

https://doi.org/10.1136/rapm-2019-101208

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    Footnotes

    • Contributors HA: study design, data collection, data analysis, data interpretation and manuscript preparation. MS: study design, data analysis, data interpretation, administration, manuscript revision and approval of final manuscript. HM and SA: data collection, data analysis and data interpretation. RI: data collection and data analysis. KF: data collection, data analysis, data interpretation, administration and approval of final manuscript. KU: study design, manuscript revision and approval of final manuscript. HY: funding acquisition, study design, data collection, data analysis, data interpretation, administration, manuscript revision and approval of final manuscript. YY: administration, manuscript revision and approval of final manuscript.

    • Funding This work was supported by grants from the Ministry of Health, Labor and Welfare of Japan (grant number: H26-Policy-011 and H26-Special-047).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available. This study was carried out using the Diagnosis Procedure Combination database, which was provided to research group (Research Representative: Hideo Yasunaga, ORCID: 0000-0002-6017-469X) from each cooperative hospital based on a confidentiality agreement through the Diagnostic Group Classification Support Organization.