Abstract
Purpose
Postoperative delirium incidences are increasing in older adults. A Cochrane Review found no significant difference in the incidence of postoperative delirium between total intravenous anesthesia (TIVA) and inhalational anesthesia (IA). This study evaluated the differences in postoperative delirium and morbidity between patients who underwent either TIVA or IA.
Methods
A nationwide Japanese inpatient database was used to retrospectively compare differences in postoperative delirium and composite morbidity between patients older than 65 years, who underwent general anesthesia (TIVA or IA). The primary outcome was postoperative delirium. The secondary outcomes were: morbidity incidence, length of hospital stay, and mortality. A 1:3 propensity score analysis of patients who underwent all surgical procedures was conducted according to covariates, to calculate odds ratios and their 95% confidence intervals (CIs). Sensitivity analyses were conducted using an instrumental variable analysis of the proportion of TIVA by hospital scale, stabilized inverse probability of treatment weighting analyses, limiting the definitions of postoperative delirium, and subgroup analysis.
Results
Of 738,600 patients, 149,540 received TIVA and 589,060 received IA. After 1:3 propensity score matching, the adjusted odds ratios for postoperative delirium and composite morbidity were 0.93 (95% CI 0.91–0.95) and 0.94 (95% CI 0.90–0.97), respectively, for TIVA concerning IA. There were no differences in the length of the intensive care unit and hospital stay, or hospital mortality. The findings were consistent with the sensitivity analyses.
Conclusions
This study demonstrated that TIVA was related to a slightly decreased postoperative delirium and incidence of morbidity compared to IA.
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Acknowledgements
The authors would like to thank Editage (www.editage.com) for English language editing. The authors would like to thank Tsubokawa Tsunehisa, Professor of Department of Anesthesiology, School of Medicine, The Jikei University.
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The authors have no sources of funding to declare for this manuscript.
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Study concept and design: MY and YM; data collection: MY; manuscript preparation: MY; manuscript editing, review, and approval: all authors.
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Ethics statement
This study was approved by the Ethics Committee of Ube Industrial Central Hospital (approval number: 138210719; August 27th, 2021); the Ethics Committee waived the need for informed consent due to the anonymized nature of the data.
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Supplementary Fig. 1 Distribution of propensity score Blue: total intravenous anesthesia; Red: inhalational anesthesia (PNG 22 KB)
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Yoshimura, M., Shiramoto, H., Morimoto, Y. et al. Comparison of total intravenous with inhalational anesthesia in terms of postoperative delirium and complications in older patients: a nationwide population-based study. J Anesth 36, 698–706 (2022). https://doi.org/10.1007/s00540-022-03101-3
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DOI: https://doi.org/10.1007/s00540-022-03101-3