The Impact of Neuraxial Versus General Anesthesia on the Incidence of Postoperative Surgical Site Infections Following Knee or Hip Arthroplasty

Zorrilla-Vaca, Andrés; Grant, Michael C.; Mathur, Vineesh; Wu, Christopher L.

doi:10.1097/aap.0000000000000437

Cited by 47 publications

(14 citation statements)

References 38 publications

(37 reference statements)

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“…29 Furthermore, our findings support those from a meta-analysis of joint arthroplasty procedures showing lower rates of surgical site infection after neuraxial anaesthesia. 30 Conversely, the effects of co-morbidities, such as coronary artery disease, hypertension, and diabetes, have not been replicated following our adjusted analyses. 31,32 This may reflect the fact that the underlying mechanisms behind these co-morbidities may interact and therefore not demonstrate an effect because of loss of statistical power.…”

Section: Discussionmentioning

confidence: 77%

Prospective observational study of postoperative infection and outcomes after noncardiac surgery: analysis of prospective data from the VISION cohort

Wan

Patel

Abbott

et al. 2020

British Journal of Anaesthesia

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Background: Infection is a frequent cause of postoperative morbidity and mortality. The incidence, risk factors, and outcomes for postoperative infections remain poorly characterised. Methods: This is a secondary analysis of a prospective international cohort study of patients aged !45 yr who had noncardiac surgery (VISION), including data describing infection within 30 days after surgery. The primary outcome was postoperative infection. The secondary outcome was 30 day mortality. We used univariable and multivariable logistic regression to identify baseline risk factors for infection. Results are presented as n (%) or odds ratio (OR) with 95% confidence intervals. Some denominators vary according to rates of missing data. Results: Among 39 996 surgical patients, 3905 (9.8%) experienced 5152 postoperative infections and 715 (1.8%) died. The most frequent infection was surgical site infection (1555/3905 [39.8%]). Infection was most strongly associated with general surgery (OR: 3.74 [3.11e4.49]; P<0.01) and open surgical technique (OR: 2.03 [1.82e2.27]; P<0.01); 30 day mortality was greater amongst patients who experienced infection (262/3905 [6.7%] vs 453/36 091 patients who did not [1.3%]; OR: 3.47 [2.84e4.22]; P<0.01). Mortality was highest amongst patients with CNS infections (OR: 14.72 [4.41e49.12]; P<0.01). Conclusions: Infection is a common and important complication of noncardiac surgery, which is associated with high mortality. Further research is needed to identify more effective measures to prevent infections after surgery.

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Section: Discussionmentioning

confidence: 77%

Prospective observational study of postoperative infection and outcomes after noncardiac surgery: analysis of prospective data from the VISION cohort

Wan

Patel

Abbott

et al. 2020

British Journal of Anaesthesia

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“…Positive pressure ventilation increases intrathoracic pressure during inspiration, which impedes venous return and thereafter facilitates the development of acute kidney injury 35 . Third, neuraxial anesthesia may reduce the risk of surgical site infection through attenuating the stress response to surgery and inducing vasodilation and consequently enhancing tissue oxygenation 36 .…”

Section: Discussionmentioning

confidence: 99%

Adverse outcomes after noncardiac surgery in patients with aortic stenosis

Tai

Chang

Yeh

et al. 2021

Sci Rep

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Whether aortic stenosis (AS) increases perioperative risk in noncardiac surgery remains controversial. Limited information is available regarding adequate anesthetic techniques for patients with AS. Using the reimbursement claims data of Taiwan’s National Health Insurance, we performed propensity score matching analyses to evaluate the risk of adverse outcomes in patients with or without AS undergoing noncardiac surgery between 2008 and 2013. We also compared the perioperative risk of AS patients undergoing general anesthesia or neuraxial anesthesia. Multivariable logistic regressions were applied to calculate the adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for postoperative mortality and major complications. The matching procedure generated 9741 matched pairs for analyses. AS was significantly associated with 30-day in-hospital mortality (aOR 1.31, 95% CI 1.03–1.67), acute renal failure (aOR 1.42, 95% CI 1.12–1.79), pneumonia (aOR 1.16, 95% CI 1.02–1.33), stroke (aOR 1.14, 95% CI 1.01–1.29), and intensive care unit stay (aOR 1.38, 95% CI 1.27–1.49). Compared with neuraxial anesthesia, general anesthesia was associated with increased risks of acute myocardial infarction (aOR 3.06, 95% CI 1.22–7.67), pneumonia (aOR 1.80, 95% CI 1.32–2.46), acute renal failure (aOR 1.82, 95% CI 1.11–2.98), and intensive care (aOR 4.05, 95% CI 3.23–5.09). The findings were generally consistent across subgroups. AS was an independent risk factor for adverse events after noncardiac surgery. In addition, general anesthesia was associated with greater postoperative complications in AS patients compared to neuraxial anesthesia. This real-world evidence suggests that neuraxial anesthesia should not be contraindicated in patients with AS.

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“…53 Preferential use of neuraxial anesthesia over general anesthesia has also been shown to improve postoperative outcomes. 54,55 In a meta-analysis, that included 16,555 patients, Liu et al demonstrated that patients undergoing knee arthroplasty had a significantly lower incidence of both pneumonia and surgical site infection within a 30 day period, when receiving neuraxial anesthesia compared to general anesthesia. 54 This is believed to be due to the lesser impact that neuraxial anesthesia has on immune function and the comparatively lower degree of surgical stress.…”

Section: Anesthetic Recommendationsmentioning

confidence: 99%

Enhanced recovery after surgery (ERAS) in clinical practice

Leger

Livelsberger

2020

APIC

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‘Enhanced Recovery After Surgery’ (ERAS) protocols are an evidence-based, multidisciplinary system for patient care that— since its emergence in 2001— has shown remarkable efficacy in reducing surgical complications, shortening length of stay (LoS), and the incidence of hospital re-admission. Unfortunately, wide spread acceptance of ERAS has been slow, as it conflicts with some traditional perioperative care practices. However, with protocol compliance >70%, studies have shown significant reduction in mortality and postsurgical complications, with 30-50% reduction in LoS and approximately a 50% reduction in complications.

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The Impact of Neuraxial Versus General Anesthesia on the Incidence of Postoperative Surgical Site Infections Following Knee or Hip Arthroplasty

Cited by 47 publications

References 38 publications

Prospective observational study of postoperative infection and outcomes after noncardiac surgery: analysis of prospective data from the VISION cohort

Prospective observational study of postoperative infection and outcomes after noncardiac surgery: analysis of prospective data from the VISION cohort

Adverse outcomes after noncardiac surgery in patients with aortic stenosis

Enhanced recovery after surgery (ERAS) in clinical practice

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