Long-term Effects of Desflurane and Sevoflurane on Mortality and Care Needs in Older Patients after Gastrointestinal Surgery: An Inverse Probability-weighted Analysis.

Introduction: Long-term mortality and activities of daily living (ADLs) outcomes in older patients who received desflurane anesthesia in real-world settings have not been evaluated. Therefore, we aimed to investigate whether the postoperative long-term care level of older patients who received desflurane was less impaired than that of patients who received sevoflurane, as well as the effects of desflurane on long-term mortality and long-term care-need level in older patients. Methods: We performed a retrospective, open-cohort study using medical and long-term care insurance (LTCI) claims data from Fukuoka Prefecture, Japan. Administrative medical claims data linked to LTCI claims data were analyzed. The study population included patients aged ≥75 years who underwent intra-abdominal surgery. The primary outcomes were 1-year mortality and deterioration in long-term care-need level after the desflurane and the sevoflurane anesthesia. An inverse probability weighting (IPW) analysis was performed to adjust for confounders. Generalized linear model analysis was performed to estimate the odds ratios (ORs) for the primary outcomes. Results: Among the 11,798 participants, 63.1% received sevoflurane and 36.9% received desflurane. The C-statistic of the propensity score for desflurane use was 0.701. In the generalized linear model analysis after IPW adjustment, desflurane did not cause deterioration in long-term care-need levels (OR, 0.931; 95% confidence interval [CI], 0.831-1.044) or reduced 1-year mortality (OR, 0.891; 95% CI, 0.782-1.016). Conclusions: Desflurane did not improve the long-term care-need level or 1-year mortality compared with sevoflurane in older patients. Therefore, we could not conclude whether desflurane improves long-term mortality or care levels.