Association between type of anesthesia and length of hospital stay in primary unilateral total knee arthroplasty patients: a single-center retrospective study

Abstract

Objective This study explored the risk factors influencing the length of hospital stay (LOS) and establish whether the type of anesthesia is independently associated with the LOS in patients after primary unilateral total knee arthroplasty (TKA). Methods In this retrospective cohort study, 2309 patients undergoing unilateral TKA were recruited between January 2013 and June 2014 in a tertiary academic medical center in Singapore. Univariate and multivariate linear regression analyses were used to identify the independent risk factors associated with LOS. Besides, subgroup and interaction analyses were performed to evaluate the relationship between the type of anesthesia and LOS. Result In total, 2309 patients were identified. Out of these, 791 patients underwent general anesthesia, whereas 1518 patients underwent regional anesthesia. Multivariate regression analyses revealed that prolonged LOS was significantly associated with age ≥ 65 years (β = 0.48; 95% CI, 0.09–0.87; P = 0.015), diabetes mellitus (DM) (β = 0.8; 95% CI, 0.33–1.27; P = 0.001), congestive cardiac failure (CCF) (β = 4.1; 95% CI, 2.02–6.17; P < 0.001), perioperative blood transfusion (β = 5.71; 95% CI, 4.86–6.56; P < 0.001), creatinine > 2 mg/dL (β = 4.54; 95% CI, 2.46–6.62; P < 0.001), ASA status (III) (β = 1.72; 95% CI, 0.72–2.71; P = 0.001), general anesthesia (β = 0.78; 95% CI, 0.41–1.66; P < 0.001). The LOS further decreased among participants receiving regional anesthesia at advanced age (age ≥ 65 years) (β = − 1.12; 95% CI, − 1.66 to − 0.58; P < 0.001), patients with BMI ≤ 25 kg/m2 (β = − 1.92; 95% CI, − 2.73 to − 1.11; P < 0.001) or ≥ 30 kg/m2 (β = − 0.58; 95% CI, − 1.1 to − 0.06; P = 0.029). Conclusion Our findings demonstrated that age ≥ 65 years, DM, CCF, perioperative blood transfusion, creatinine > 2 mg/dL, ASA status (III), general anesthesia are associated with a prolonged LOS after primary TKA. Elderly patients (age ≥ 65 years) and patients with BMI ≤ 25 kg/m2 or ≥ 30 kg/m2 receiving regional anesthesia have a further reduced LOS. Therefore, when TKA is performed, priority for regional anesthesia is given to the elderly patients (age ≥ 65 years old) and those with BMI ≤ 25 kg/m2 or ≥ 30 kg/m2.

Factors affecting the length of hospital stay for total knee arthroplasty in Japan: a retrospective study using the diagnosis procedure combination database

“…This is consistent with the findings of the present study. General anesthesia has been reported to prolong the length of hospital stay in patients undergoing unilateral TKA [ 20 , 21 ]; this is also consistent with our findings. However, contrastingly, some studies have shown that the method of anesthesia does not affect the length of hospital stay [ 22 ].…”

Factors affecting the length of hospital stay for total knee arthroplasty: a retrospective database study using Diagnosis Procedure Combination

“…Although general and local anesthesia, including spinal subarachnoid anesthesia, are suitable for TKA,, local anesthesia has been reported to shorten the length of hospital stay compared to general anesthesia [17][18][19] , which was consistent with the ndings of the present study. General anesthesia has been previously reported to prolong the length of hospital stay in patients undergoing unilateral TKA 20,21 , consistent with our ndings. However, contrastingly, some studies have shown that the method of anesthesia does not affect the length of hospital stay 22 .…”

Differences in Regional Anesthesia Utilization by Hospital Region in the United States

“…Regional techniques for TAH are evolving and represent a relatively new indication for the use of RA, with either quadratus lumborum block 21 , superior hypogastric block 22 , or transversus abdominis plane block 23 . For this reason, it is not surprising for RA utilization rates to be lower for this relatively newer indication than for more established surgical indications such as TSA 24 and TKA [25][26][27][28] . In addition, a study Cozowicz et al 16 in 2016 documented the use of neuraxial anesthesia for TKA between 2006 to 2013 as 24.7%-21.3%, and the use of peripheral nerve blocks for TKA during the same time period as increasing from 10.3-20.4%.…”