經尿道前列腺切除術病患接受半身與全身麻醉的風險分析

劉永浩、顏維晨、高建璋、曹智惟、蒙恩

國防醫學院三軍總醫院外科部泌尿外科

Complication Analysis of Transurethral Resection of Prostate Under Different Types of Anesthesia: A Nationwide, Population-based Cohort Study

Yung-Hao Liu, Wei-Chen Yen, Chien-Chang Kao, Chih-Wei Tsao, En Meng

Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

Purpose: Transurethral resection of prostate (TURP) is mostly performed under spinal anesthesia (SA); fewer under general anesthesia (GA). With their distinct pros and cons, the choice of anesthesia is guided by the patient’s coexisting diseases and the patient’s preference. However, there is lacking in objective evaluation whether TURP patients under GA have accompanying higher complication rates. We aimed to analyze the relationship between their comorbidities, types of anesthesia (spinal or general), post-operative complications, and further formulate an appraisal system.

Materials and Methods: We identified 138823 individuals who had undergone TURP with anesthesia between 2000 and 2015 from Taiwan's National Health Insurance Research Database (NHIRD), of which 35294 (25.4%) received general anesthesia (GA), and 103529 (74.6%) received spinal anesthesia (SA). By closely examining, 10527 individuals undergoing TURP under GA and 57076 under SA were enrolled. Cox proportional hazards regression models were used for examining the factors of complication. The Kaplan-Meier method was used for calculating the cumulative risk of complication among TURP aged 18 and over stratified by anesthesia types with log-rank test.

Results: The Kaplan-Meier analysis revealed that the cumulative risk of complication was not significantly different between GA and SA group (Log-rank, P=0.574). Furthermore, we compared such risks during inpatient department (IPD) (Log-rank, P=0.554) and 3 months after TURP (Log-rank, P=0.760), and neither of them showed significant differences. Complication risk of re-hospital after 30 days of discharge was also not significantly different between two groups (Log-rank, P=0.989).

Conclusion: Based on our study, patients receiving TURP under GA or SA present with similar complication rate, regardless of their comorbidities or age.