General vs Spinal Anesthesia for Total Joint Arthroplasty: A Single-Institution Observational Review |
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| Institution: | 1. Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA;2. Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA;1. Queensland University of Technology, Brisbane, Queensland, Australia;2. Orthopaedic Research Unit, The Prince Charles Hospital, Brisbane, Queensland, Australia;1. Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH;2. Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY;3. Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL;1. Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Murdoch, WA, Australia;2. The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia;3. Department of Surgery, The University of Western Australia, Nedlands, WA, Australia;4. Department of Pathophysiology, University of Tartu, Tartu, Estonia;5. Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany;6. Department of Traumatology and Orthopaedics, University of Tartu, Tartu, Estonia;7. Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Tartu, Estonia |
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| Abstract: | BackgroundTotal joint arthroplasty (TJA) can be successfully carried out under general (GA) or spinal anesthesia (SA). The existing literature does not adequately illustrate which technique is optimal. The purpose of this study is to prospectively compare the effects of anesthesia technique on TJA outcomes.MethodsThis 2-year, prospective, observational study was conducted at a single institution where patients receiving primary TJA were consecutively enrolled. Patients were contacted postoperatively to assess for any 90-day complications. The primary outcome of the study was the overall complication rate.ResultsA total of 2242 patients underwent total hip arthroplasty (n = 656; 29.26%) or total knee arthroplasty (n = 1586; 70.74%) between 2015 and 2017. Of these procedures, 1325 (59.10%) were carried out under SA and 917 (40.90%) were carried out under GA. Patients in the GA cohort had higher mean Charlson Comorbidity Index scores (0.05 SA vs 0.09 GA; P < .05) and higher average body mass index (29.35 SA vs 30.24 GA; P < .05). On multivariate analysis, patients in the SA cohort had a significantly lower overall complication rate relative to their GA counterparts (7.02% vs 10.14%; odds ratio, 0.66; 95% confidence interval, 0.49-0.90; P < .05). In addition, length of stay in the GA cohort was significantly longer (2.43 SD, 1.62] vs 2.18 SD, 0.88] days; P < .01) and a larger percentage of GA patients were discharged to a nursing facility (32.28% vs 25.06%; odds ratio, 0.55; 95% confidence interval, 0.44-0.70; P < .05).ConclusionOur study demonstrates that SA for TJA is associated with a decrease in overall complications and healthcare resource utilization. |
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| Keywords: | total joint arthroplasty general anesthesia spinal anesthesia outcomes complications |
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