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Un estudio retrospectivo multicéntrico sobre los métodos de anestesia y su impacto en los resultados neurocognitivos

Gengrui Zhong¹, Xiaoli Huang², Congye Li¹

¹Department of Critical Care Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Frontiers in medicine

|August 27, 2025

Resumen

Las técnicas de anestesia regional, como la anestesia espinal (SA), reducen significativamente el riesgo de delirio postoperatorio (POD) e infecciones pulmonares en pacientes ancianos con fractura de cadera. La anestesia general puede aumentar el riesgo de infección pulmonar.

Área de la Ciencia:

Anestesiología
Medicina para la edad avanzada
Cirugía ortopédica

Sus antecedentes:

Los trastornos neurocognitivos postoperatorios (TNP) y las complicaciones son preocupaciones significativas en pacientes de edad avanzada sometidos a cirugía de fractura de cadera.
La elección de la anestesia puede influir en los resultados del paciente, pero la evidencia que compara varias técnicas en esta población es limitada.

Objetivo del estudio:

Evaluar el impacto de las diferentes técnicas de anestesia en los trastornos neurocognitivos perioperatorios (TNP) y otras complicaciones postoperatorias en pacientes de edad avanzada sometidos a hemiartroplastia por fracturas de cadera.

Principales métodos:

Un estudio retrospectivo multicéntrico incluyó a 5.005 pacientes ancianos (≥65 años) sometidos a hemiartroplastia de cadera.
Los pacientes fueron agrupados por anestesia: anestesia por inhalación intravenosa (IVA+IHA), IVA+IHA con bloqueo nervioso periférico (PNB), IVA con PNB, anestesia espinal (SA), y SA con PNB.
Se evaluó el delirio postoperatorio (POD) utilizando CAM; se evaluó la recuperación neurocognitiva retardada (DNR) en el día 7; se registraron otras complicaciones y mortalidad.

Principales resultados:

La anestesia espinal (SA) y la SA con PNB redujeron significativamente el riesgo de POD (63-67% de reducción) en comparación con las técnicas de anestesia general.
No se observaron diferencias significativas en la recuperación neurocognitiva retrasada (DNR) entre los grupos.
Las tasas de infección pulmonar postoperatoria (IP) fueron significativamente más altas con anestesia general en comparación con la anestesia regional.

Conclusiones:

La anestesia regional, particularmente la espinal, parece estar asociada con tasas más bajas de delirio postoperatorio temprano e infecciones pulmonares en pacientes ancianos sometidos a hemiartroplastia de cadera.
Se necesitan estudios prospectivos adicionales para confirmar estos hallazgos.

Palabras clave:

Métodos de anestesia retraso en la recuperación neurocognitiva pacientes ancianos fractura de cadera delirio postoperatorio

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