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General anesthesia is not associated with dementia in older adults with osteoarthritis for hip/knee replacements, a national population-based nested case-control study - 25/04/24

Doi : 10.1016/j.jclinane.2024.111449 
Yuting Lin a, b, 1, Chun-Chia Chen a, c, 1, Chen Dong f, Yu-Ze Luan f, Jing-Yang Huang a, g, , James Cheng-Chung Wei a, d, h, ⁎⁎ , Jeng-Yuan Chiou e, ⁎⁎
a Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan 
b Department of Anesthesiology, Chung Shan Medical University Hospital, Taichung, Taiwan 
c Division of Plastic Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan 
d Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan 
e School of Health Policy and Management, Chung Shan Medical University, Taichung, Taiwan 
f School of Medicine, Chung Shan Medical University, Taichung, Taiwan 
g Center for Health Data Science, Chung Shan Medical University Hospital, Taichung, Taiwan 
h Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan 

Corresponding author at: Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.Institute of MedicineChung Shan Medical UniversityTaichungTaiwan⁎⁎Corresponding authors.

Abstract

Background

Dementia is a prevalent neurological condition, yet the relationship between dementia and general anesthesia remains uncertain. The study aimed to explore the association between general anesthesia and dementia using a nationwide population-based database.

Methods

The study extracted data from Taiwan's national health insurance, which encompassed the records of one million insured residents. A total of 59,817 patients aged 65 years and above, diagnosed with osteoarthritis between 2002 and 2010, were included. Among these patients, 3277 individuals with an initial diagnosis of dementia between 2004 and 2013 were matched with non-dementia patients based on age, gender, and the date of osteoarthritis diagnosis. Following a 1:2 random matching, the case group included 2171 patients with dementia, while the control group consisted of 4342 patients without dementia. The data was analyzed using conditional and unconditional logistic regressions.

Results

No significant differences in the odds of dementia were found between individuals exposed to general and regional anesthesia during hip/knee replacement surgeries (OR = 1.11; 95%CI: 0.73–1.70), after adjusting for age, sex, and co-morbidities. Similarly, there were no significant differences in the odds of dementia based on different durations of anesthesia exposure (General: <2 h: OR = 0.91, 95%CI = 0.43–1.92; 2-4 h: OR = 1.21, 95%CI = 0.82–1.79; >4 h: OR = 0.39, 95%CI = 0.15–1.01; compared to no exposure. Regional: <2 h: OR = 1.18, 95%CI = 0.85–1.62; 2-4 h: OR = 0.9, 95%CI = 0.64–1.27; >4 h: OR = 0.55, 95%CI = 0.15–1.96; compared to no exposure). Likewise, no significant differences were observed in the odds of dementia based on the number of replacement surgeries (twice: OR = 0.74, 95%CI = 0.44–1.23, compared to once).

Conclusion

Neither general anesthesia nor regional anesthesia in hip/knee surgery was associated with dementia. Different numbers and durations of anesthesia exposure showed no significant differences in the odds for dementia.

Le texte complet de cet article est disponible en PDF.

Highlights

Data were from Taiwan's national health insurance, a nationwide population-based database.
No significant differences in dementia odds were found between general and regional anesthesia.
No significant differences in dementia odds were found between different durations and number of anesthesia.
Conditional and unconditional logistic regressions are used in this nested case control study.

Le texte complet de cet article est disponible en PDF.

Keywords : Dementia, General anesthesia, Osteoarthritis, Hip/knee surgery, A national population-based nested case-control study


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