Regional versus general anesthesia for ambulatory total hip and knee arthroplasty

Baratta, Jaime L.; Schwenk, Eric S.

doi:10.1097/aco.0000000000001170

Cited by 10 publications

(5 citation statements)

References 37 publications

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“…only procedure by Medicare/Medicaid, the duration of LOS -a factor representing both clinical outcomes and significant cost to the healthcare system -is an important consideration [23]. Outpatient TJAs have been found to have both lower complication rates and increased cost savings when compared to inpatient TJAs [24].…”

Section: Financial Supportmentioning

confidence: 99%

Untitled

2024

Transl Perioper Pain Med

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Furthermore, while hip fractures are typically treated with hip hemiarthroplasty, THAs may sometimes be used for surgical treatment. Although the incidence of hip fractures is declining due to various factors, the number of hip fractures in the United States is still expected to increase 1.9-fold by the year 2050, potentially leading to an increase in THA procedures performed [3]. Discussion Effects on post-operative complicationsA multitude of data exists on the varying efficacy of either spinal or general anesthesia for THA operations, with a wide variation in study results reported. Such data often looks at a variety of factors including mortality, surgical site infections (SSI), deep vein thrombosis (DVT), myocardial infarction (MI), stroke, and hospital length of stay (LOS). In one 2016 metaanalysis of 13 studies comprising over 350,000 patients who underwent THA or total knee arthroplasties (TKA), neuraxial anesthesia was significantly associated with a reduction of postoperative surgical site infections compared to general anesthesia (OR = 0.84; 95% CI 0.76 to 0.92; P < 0.001) [4]. Another analysis of 21 randomized control trials found that regional anesthesia reduced operating time (aOR -0.19, 95% CI -0.33 to -0.05), the need for transfusion (OR 0.45, 95% CI 0.22 to 0.94), and thromboembolic disease (OR 0.45, 95% CI 0.24 to 0.84) [5]. While an investigation by Pu and Sun (2019) did not find a difference in blood loss and DVT occurrence in their analysis of 5 RCTs, they did note a significant reduction in nausea occurrence (RR 3.04, 95% CI 1.69 to 5.50) and LOS (WMD 1.00, 95% CI 0.59 to 1.41 days) in spinal compared to general anesthesia [6].In addition, several studies have replicated similar findings in specific patient populations. Among a data analysis of 30,000 patients with sleep apnea, found lower rates of complications postoperatively in neuraxial anesthesia, compared to combined neuraxial and general or general (16.0%, 17.2%, 18.1%) [7]. A study conducted

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Section: Financial Supportmentioning

confidence: 99%

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2024

Transl Perioper Pain Med

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“…Although there are some absolute contraindictions to SA (patient refusal, spinal pathology, coagulopathy, etc. ), much of the choice between GA and SA often comes down to provider preference in the absence of contraindications [1]. While some studies have demonstrated decreased postoperative complications using SA [2][3][4], others have shown it to be non-superior to modern GA techniques even for rapid recovery [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Spinal anesthesia is a grossly underutilized gold standard in primary total joint arthroplasty: propensity-matched analysis of a national surgical quality database

et al. 2023

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Background There is currently no consensus regarding the optimal anesthetic technique for total hip and knee arthroplasty (THA, TKA). This study aimed to compare the utilization rates and safety of spinal vs. general anesthesia in contemporary THA/TKA practice. Methods Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), a retrospective review of 307,076 patients undergoing total hip or knee arthroplasty under either spinal or general anesthesia between January 2015 and December 2018 was performed. Propensity matching was used to compare differences in operative times, hospital length of stay, discharge destination, and 30-day adverse events. The annual utilization rates for both techniques between 2011 and 2018 were also assessed. Results Patients receiving spinal anesthesia had a shorter length of stay (P < 0.001) for TKA while no statistical differences in length of stay were observed for THA. Patients were also less likely to experience any 30-day complication (OR = 0.82, P <0.001 and OR = 0.92, P < 0.001 for THA and TKA, respectively) while being more likely to be discharged to home (OR = 1.46, P < 0.001 and OR = 1.44, P < 0.001 for THA and TKA, respectively). Between 2011 and 2018, spinal anesthesia utilization only increased by 1.4% for THA (P < 0.001) and decreased by 0.2% for TKA (P < 0.001), reaching 38.1% and 40.3%, respectively. Conclusion Spinal anesthesia remains a grossly underutilized tool despite providing better perioperative outcomes compared to general anesthesia. As orthopedic surgeons navigate the challenges of value-based care, spinal anesthesia represents an invaluable tool that should be considered the gold standard in elective, primary total hip and knee arthroplasty.

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“…Although the best choice of anaesthesia technique for major orthopaedic surgery is a matter of debate, spinal anaesthesia is an established component of perioperative management for fast-track lower limb arthroplasty [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

Perioperative Outcomes in Patients Who Received Spinal Chloroprocaine for Total Hip or Knee Arthroplasty—Consecutive Case Series Study

Alhefeiti

Patrascu

Lustig

et al. 2022

JCM

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Spinal anaesthesia is an established component of perioperative management for fast-track lower limbs arthroplasty. Short-acting local anaesthetics may present an interesting option for primary non-complicated knee (TKA) and hip (THA) arthroplasty. We describe the perioperative outcomes in patients operated under fixed 50 mg spinal chloroprocaine for total hip and knee replacement. In this retrospective case series study, 65 patients were analysed (median age 65 years, 55% females, benefit from THA (n = 31), TKA (n = 25), and unicompartmental knee arthroplasty (n = 9)). In all cases, anaesthesia duration (87 min) was sufficient for successful surgery (52 min). Up to 45% of patients (THA and less in TKA) developed postoperative pain in the post-anaesthesia care unit (PACU), requiring intravenous morphine titration (up to 7.5 mg). One patient developed severe breakthrough pain requiring advanced regional analgesia. The median PACU stay was up to 97 min (less in TKA), and the incidence of nausea and urinary retention was low. All patients were able to start physical therapy on the same day of surgery. These findings encourage the use of a short-acting agent for spinal anaesthesia in patients with primary non-complicated arthroplasty; however, the relay analgesia should be systematically implemented to avoid breakthrough pain in PACU.

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Regional versus general anesthesia for ambulatory total hip and knee arthroplasty

Cited by 10 publications

References 37 publications

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Spinal anesthesia is a grossly underutilized gold standard in primary total joint arthroplasty: propensity-matched analysis of a national surgical quality database

Perioperative Outcomes in Patients Who Received Spinal Chloroprocaine for Total Hip or Knee Arthroplasty—Consecutive Case Series Study

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