文献学习|老年患者手术麻醉后会增加老年痴呆风险么？

确定老年人的手术和麻醉是否可能促进阿尔茨海默氏病和相关性痴呆（ADRD）。

关于手术和麻醉促进ADRD的假说存在大量矛盾的文献。许多文献因手术适应症而混淆或样本量较小。这项研究检查了老年阑尾炎患者，这是一种常见病，在控制了一些已知的关联后，大多数情况下会随机发作。

利用2002年至2017年的医疗保险数据，对因阑尾炎接受阑尾切除术的患者与没有阑尾炎的对照组患者进行了匹配的自然实验，检查了54996名以前没有诊断出ADRD、认知障碍或神经系统退化的患者，他们在68岁至77岁之间发生阑尾炎并接受了阑尾切除术（"阑尾切除术 "治疗组），将他们与274980名对照组5：1匹配，检查了随后发生ADRD的危险。

阑尾切除术组发生ADRD或死亡的危险比（HR）低于对照组。HR = 0.96 (95% CI 0.94, 0.98), P < 0.0001, (在7.5年内，阑尾手术组的28.2%vs对照组的29.1%)。死亡的HR为0.97（0.95，0.99），P = 0.002，（7.5年时22.7%对23.1%）。单独发生ADRD的HR为0.89（0.86，0.92），P＜0.0001，（7.5年时，阑尾切除术的7.6%vs对照组的8.6%）。在亚组分析中没有发现阑尾切除术组的ADRD发生率明显升高。

在这项涉及329,976名老年患者的自然实验中，接受阑尾切除术和麻醉并没有增加随后的ADRD发生率。

 

编者注

 

这项新的研究利用医疗保险数据库对近55,000名年龄在68至77岁之间、没有ADRD、因阑尾炎需要进行阑尾手术的患者（治疗组）与近275,000名在年龄和其他多种因素上匹配的、在匹配前没有阑尾炎迹象和没有阑尾手术的患者（对照组）的这种风险进行了比较 。经过7.5年的随访，治疗组的ADRD率实际上较低（7.6%对8.6%）。

然而，这些令人欣慰的发现可能并不普遍适用于接受比阑尾切除术更大、更具侵入性的手术的老年患者。

Objective: 

To determine if surgery and anesthesia in the elderly may promote Alzheimer's Disease and Related Dementias (ADRD).

Background: 

There is a substantial conflicting literature concerning the hypothesis that surgery and anesthesia promotes ADRD. Much of the literature is confounded by indications for surgery or has small sample size. This study examines elderly patients with appendicitis, a common condition that strikes mostly at random after controlling for some known associations.

Methods: 

A matched natural experiment of patients undergoing appendectomy for appendicitis versus control patients without appendicitis using Medicare data from 2002 to 2017, examining 54,996 patients without previous diagnoses of ADRD, cognitive impairment, or neurological degeneration, who developed appendicitis between ages 68 through 77 years and underwent an appendectomy (the “Appendectomy” treated group), matching them 5:1 to 274,980 controls, examining the subsequent hazard for developing ADRD.

Results: 

The hazard ratio (HR) for developing ADRD or death was lower in the Appendectomy group than controls: HR = 0.96 (95% CI 0.94, 0.98), P < 0.0001, (28.2% in Appendectomy versus 29.1% in controls, at 7.5 years). The HR for death was 0.97 (0.95, 0.99), P = 0.002, (22.7% versus 23.1% at 7.5 years). The HR for developing ADRD alone was 0.89 (0.86, 0.92), P < 0.0001, (7.6% in Appendectomy versus 8.6% in controls, at 7.5 years). No subgroup analyses found significantly elevated rates of ADRD in the Appendectomy group.

Conclusions: 

In this natural experiment involving 329,976 elderly patients, exposure to appendectomy surgery and anesthesia did not increase the subsequent rate of ADRD.