Spinal Compared with General Anesthesia in Contemporary Primary Total Hip Arthroplasties

Abstract

Background: The specific advantages of spinal anesthesia compared with general anesthesia for primary total hip arthroplasty (THA) remains unknown. Therefore, this study aimed to investigate the pain control, length of stay, and postoperative outcomes associated with spinal anesthesia compared with general anesthesia in a large cohort of primary THAs from a single, high-volume academic institution.Methods: We retrospectively identified 13,730 primary THAs (11,319 patients) from 2001 to 2016 using our total joint registry. Of these cases, 58% had general anesthesia and 42% had spinal anesthesia. The demographic characteristics were similar between groups, with mean age of 64 years, 51% female, and mean body mass index (BMI) of 31 kg/m 2 . Data were analyzed using an inverse probability of treatment weighted model based on a propensity score that accounted for numerous patient and operative factors. The mean follow-up was 6 years.Results: Patients treated with spinal anesthesia had lower Numeric Pain Rating Scale (NPRS) scores (p < 0.001) and required fewer postoperative oral morphine equivalents (OMEs) at all time points evaluated (p < 0.001). Patients treated with spinal anesthesia also had shorter hospital length of stay (p = 0.02), fewer altered mental status events (odds ratio [OR], 0.7; p = 0.02), and fewer intensive care unit (ICU) admissions (OR, 0.7; p = 0.01). There was no difference in the incidence of deep vein thrombosis (p = 0.8), pulmonary embolism (p = 0.4), 30-day readmissions (p = 0.17), 90-day readmissions (p = 0.18), all-cause revisions (p = 0.17), or all-cause reoperations (p = 0.14). Conclusions:In this large, single-institution study, we found that spinal anesthesia was associated with reduced pain scores and OME use postoperatively. Furthermore, spinal anesthesia resulted in fewer altered mental status events and ICU admissions. These data favor the use of spinal anesthesia in primary THAs.

General Anesthesia Versus Regional Anesthesia in the Elderly Patients Undergoing Hip Fracture Surgeries: A Systematic Review and Meta‐Analysis of Randomized Clinical Trials

“…The length of hospital stay is often used as a proxy for postoperative complications and healthcare resource utilization. Consistent with findings of several retrospective cohort studies, RA also decreases the length of hospital stay relative to GA [49,50]. Notably, shorter hospital stays mean not only fewer financial costs for patients and burden on healthcare system, but also reduced exposure of frail patients to hospital-acquired infections.…”

Risk factors for hypoxaemia following hip fracture surgery in elderly patients who recovered from COVID-19: a multicentre retrospective study

“…We also found that general anaesthesia was an independent risk factor for postoperative hypoxaemia, which may be related to postoperative pain, opioid administration, and postoperative muscular strength. A study has shown that for hip surgery, compared with general anaesthesia, patients who received intrathecal anaesthesia had lower pain scores at all evaluated time points and required less postoperative oral morphine ( 33 ). Postoperative pain was associated with postoperative hypoxaemia.…”

Frequency of Transfusions and Risk Factor for Bleeding Risk to Guide a Blood-Sparing Program during Hip Arthroplasty in Gabon

“…Owen and al, patients who received spinal anesthesia had lower mean pain scores throughout length of their hospitalizations, and required fewer blood transfusions (OR, 0.7), length of stay was not significantly different between the groups, and there was no difference in readmissions at 30 or 90 days or venous thromboembolic events at 90 days [24]. The Memtsoudis meta-analysis (94 studies) also shows a reduction in bleeding and transfusion in patients undergoing spinal anesthesia [25].…”