Two types of anaesthesia and length of hospital stay in patients undergoing unilateral total knee arthroplasty (TKA): a secondary analysis based on a single-centre retrospective cohort study in Singapore

Abstract

Background Evidence regarding the relationship between the type of anaesthesia and length of hospital stay is controversial. Therefore, the objective of this research was to investigate whether the type of anaesthesia was independently related to the length of hospital stay in patients undergoing unilateral total knee arthroplasty (TKA) after adjusting for other covariates. Methods The present study was a cohort study. A total of 2622 participants underwent total knee arthroplasty (TKA) at a hospital in Singapore from 2013 to 1-1 to 2014-6-30. The target independent variable and the dependent variable were two types of anaesthesia and length of hospital stay, respectively. The covariates included age, BMI, hemoglobin (Hb), length of stay (LOS), duration of surgery, sex, ethnicity, American Society of Anesthesiologist (ASA) Status, smoking, obstructive sleep apnea (OSA), diabetes mellitus (DM), DM on insulin, ischemic heart disease (IHD), congestive cardiac failure (CCF), cerebrovascular accident (CVA), creatinine > 2 mg/dl, day of week of operation. Multivariate linear and logistic regression analyses were performed on the variables that might influence the choice of the two types of anaesthesia and the LOS. This association was then tested by subgroup analysis using hierarchical variables. Results The average age of 2366 selected participants was 66.57 ± 8.23 years old, and approximately 24.18% of them were male. The average LOS of all enrolled patients was 5.37 ± 4.87 days, 5.92 ± 6.20 days for patients receiving general anaesthesia (GA) and 5.09 ± 3.98 days for patients receiving regional anaesthesia (RA), P < 0.05. The results of fully adjusted linear regression showed that GA lasted 0.93 days longer than RA (β = 0.93, 95% CI (0.54, 1.32)), P < 0.05. The results of fully adjusted logistic regression showed that LOS > 6 days was 45% higher for GA than for RA (OR = 1.45, 95% CI (1.15, 1.84)), P < 0.05. Through the subgroup analysis, the results were basically stable and reliable. Conclusion Our study showed that GA increased the length of stay during unilateral TKA compared with RA. This finding needs to be validated in future studies.

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 .…”

A novel predictive model of hospital stay for Total Knee Arthroplasty patients

“…Total Knee Arthroplasty (TKA) is the primary surgical procedure for treating severe knee disorders, relieving knee pain, and reestablishing knee function (1). It can help patients restore knee joint function and improve their quality of life (2).…”