General anesthesia might be associated with early periprosthetic joint infection: an observational study of 3,909 arthroplasties

Abstract

Background and purpose — Periprosthetic joint infection (PJI) remains a devastating complication following total knee or total hip arthroplasty (TKA/THA). Nowadays, many studies focus on preventive strategies regarding PJI; however, the potential role of anesthesia in the development of PJI remains unclear.Patients and methods — All consecutive patients undergoing elective primary unilateral TKA or THA from January 2014 through December 2017 were included. Exclusion criteria included femoral fractures as the indication for surgery and previously performed osteosynthesis or hardware removal on the affected joint. Age, sex, BMI, ASA classification, type of arthroplasty surgery, type of anesthesia, duration of surgery, smoking status, and intraoperative hypothermia were recorded. Propensity score-matched univariable logistic regression analysis was used to control for allocation bias.Results — 3,909 procedures consisting of 54% THAs and 46% TKAs were available for analysis. 42% arthroplasties were performed under general anesthesia and 58% under spinal anesthesia. Early PJIs were observed in 1.7% of the general anesthesia group and in 0.8% in the spinal anesthesia group. The multivariable logistic regression model demonstrated an odds ratio for PJI of 2.0 (95% CI 1.0–3.7) after general anesthesia relative to the propensity score-matched patients who received spinal anesthesia.Interpretation — These results suggest a potential association between general anesthesia and early PJI. Future research using large-scale data is required to further elucidate this clinically relevant association.

Preoperative Risk Prediction Models for Short-Term Revision and Death After Total Hip Arthroplasty

“…Penalized Lasso regression identified male sex, higher BMI, higher ASA class, and general anesthesia as the most important factors increasing the risk of periprosthetic joint infection. Notably, all of these factors have also been previously reported as risk factors for periprosthetic joint infection 27 - 29 . Although previous analyses have also suggested that comorbid conditions may increase the risk of periprosthetic joint infection 30 , we did not include them because of the unavailability of the comorbidity data.…”

Mortality of patients with COVID‐19 who undergo an elective or emergency surgical procedure: a systematic review and meta‐analysis

“…This inflammatory response may also lead to acute cardiac injury and myocarditis as well as thromboembolic disease and disseminated intravascular coagulation 53,54 . Surgery may act as a promotor of these pathways by contributing to the pro‐inflammatory state, 55,56 while also causing additional strain on the heart and lungs 57–59 …”

“…[50][51][52] This inflammatory response may also lead to acute cardiac injury and myocarditis as well as thromboembolic disease and disseminated intravascular coagulation. 53,54 Surgery may act as a promotor of these pathways by contributing to the proinflammatory state, 55,56 while also causing additional strain on the heart and lungs. [57][58][59] The magnitude of the increased risk that a COVID-19 coinfection poses in the perioperative period mandates the development of strategies aimed at minimizing the risk of surgery to patients during the COVID-19 pandemic both at the individual and at a system level.…”

Postoperative Hyperglycemia in Patients with and without Diabetes After Major Joint Replacement

“…The effect of insulin was then compared with other potential predictors of positive clinical cultures in all patients without diabetes. Insulin usage had a larger effect on reducing positive cultures than the avoidance of general anesthesia (Table VI), which has been associated with infections after joint surgery 13 , 14 .…”