Effect of spinal versus general anesthesia on thirty-day outcomes following total hip arthroplasty: A matched-pair cohort analysis |
| |
| Institution: | 1. Department of Anesthesiology, University of Virginia Health, Charlottesville, VA, United States of America;2. School of Medicine, University of Virginia, Charlottesville, VA, United States of America;1. Department of Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ, United States of America;2. Department of Orthopaedics, New Jersey Medical School, Newark, NJ, United States of America;3. American Preventive Screening & Education Association (APSEA), Stratford, NJ, United States of America;1. Department of Anesthesiology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China;2. Fujian Provincial Key Laboratory of Emergency Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Fujian Provincial Co-Constructed Laboratory of “Belt and Road”, Fujian Emergency Medical Center, Fuzhou, China;1. Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, United States of America;2. Department of Anesthesiology, Center for Blood Conservation, Duke University Medical Center, Durham, NC, United States of America;3. Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, United States of America;4. Department of Medicine (Hematology), Oncology, and Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, United States of America;1. Department of Anaesthesia and Pain Service, Princess Margaret Hospital, Lai Chi Kok, Kowloon, Hong Kong;2. Heart Failure and Structural Heart Disease Research Unit, Cardiovascular Analytics Group, Hong Kong, China;3. Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Shatin, New Territories, Hong Kong;1. Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA;2. Harvard Medical School, Boston, MA, USA;3. Department of Anesthesia, Brigham & Women''s Hospital, Boston, MA, USA;4. STRATUS Center for Medical Simulation, Brigham & Women''s Hospital, Boston, MA, USA;5. Center for Medical Simulation, Charlestown, MA, USA |
| |
| Abstract: | Study objectiveIt has not yet been established whether total hip arthroplasty complications are associated with anesthetic technique (spinal versus general). This study assessed the effect of spinal versus general anesthesia on health care resource utilization and secondary endpoints following total hip arthroplasty.DesignPropensity-matched cohort analysis.SettingAmerican College of Surgeons National Surgical Quality Improvement Program participating hospitals from 2015 to 2021.PatientsPatients undergoing elective total hip arthroplasty (n = 223,060).InterventionsNone.MeasurementsThe a priori study duration was 2015 to 2018 (n = 109,830). The primary endpoint was 30-day unplanned resource utilization, namely readmission and reoperation. Secondary endpoints included 30-day wound complications, systemic complications, bleeding events, and mortality. The impact of anesthetic technique was investigated with univariate analyses, multivariable analyses, and survival analyses.Main resultsThe 1:1 propensity-matched cohort included 96,880 total patients (48,440 in each anesthesia group) from 2015 to 2018. On univariate analysis, spinal anesthesia was associated with a lower incidence of unplanned resource utilization (3.1% 1486/48440] vs 3.7% 1770/48440]; odds ratio OR], 0.83 95% CI, 0.78 to 0.90]; P < .001), systemic complications (1.1% 520/48440] vs 1.5% 723/48440]; OR, 0.72 95% CI, 0.64 to 0.80]; P < .001), and bleeding events requiring transfusion (2.3% 1120/48440] vs 4.9% 2390/48440]; OR, 0.46 95% CI, 0.42 to 0.49]; P < .001). On multivariable analysis, spinal anesthesia remained an independent predictor of unplanned resource utilization (adjusted odds ratio AOR], 0.84 95% CI, 0.78 to 0.90]; c = 0.646), systemic complications (AOR, 0.72 95% CI, 0.64 to 0.81]; c = 0.676), and bleeding events (AOR, 0.46 95% CI, 0.42 to 0.49]; c = 0.686). Hospital length of stay was also shorter in the spinal anesthesia cohort (2.15 vs 2.24 days; mean difference, ?0.09 95% CI, ?0.12 to ?0.07]; P < .001). Similar findings were observed in the cohort from 2019 to 2021.ConclusionsTotal hip arthroplasty patients receiving spinal anesthesia experience favorable outcomes compared to propensity-matched general anesthesia patients. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
