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EP169 Anesthetic choice and outcomes in total hip and knee arthroplasty patients 2006–2021
  1. Alex Illescas1,
  2. Haoyan Zhong1,
  3. Jashvant Poeran2,
  4. Crispiana Cozowicz3,
  5. Jiabin Liu1,4 and
  6. Stavros G Memtsoudis1,4,5
  1. 1Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, USA
  2. 2Institute for Healthcare Delivery Science, Department of Population Health Science and Policy/Department of Orthopedics/Department of Medicine, Icahn School of Medicine at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, USA
  3. 3Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
  4. 4Department of Anesthesiology, Weill Cornell Medicine, New York, USA
  5. 5Department of Health Policy and Research, Weill Cornell Medical College, New York, USA


Background and Aims Neuraxial anesthesia use with improved postoperative outcomes has been widely debated and its utilization has likely changed over time. Data from total hip and knee arthroplasty (THA/TKA) patients were used to assess anesthesia choice and compare choice of anesthesia with several complications and resource utilization outcomes from 2006–2021.

Methods After Institutional Review Board approval (IRB #2012-050), using the Premier Healthcare Database we identified patients undergoing a THA/TKA from 2006–2021. Demographics, complications, resource utilization and anesthetic choice (general, neuraxial, and combined general-neuraxial) were analyzed. We used logistic regression models to compare complication and resource utilization outcomes between neuraxial vs. general anesthesia, and neuraxial vs. combined anesthesia groups. Patients with missing anesthesia were excluded from analysis.

Results We identified 906,364 THA patients and 1,603,324 TKA patients. General anesthesia was used in 71.0% of procedures, neuraxial anesthesia in 17.2%, and combined anesthesia in 11.8%. General anesthesia use [range: 63.3% to 76.4%] decreased from 70.4% in 2006 to 64.8% in 2021, neuraxial use increased from 12.4% to 28.2%, and combined use decreased from 17.2% to 7.0% (figure 1). After adjustment, we found decreased odds for all outcomes among patients who received neuraxial anesthesia in comparison with patients under general anesthesia (table 1).

Abstract EP169 Figure 1

Annual anesthesia choice percentages among total hip and knee arthroplasty patients from 2006 to 2021

Abstract EP169 Table 1

Results from multivariable logistic regression models for total hip and knee arthroplasty patients assessing anesthesia use and complications/resource utilization

Conclusions Neuraxial anesthesia use for THA/TKA increased from 2006–2021, whereas the use of general anesthesia and combined anesthesia decreased. Neuraxial use is associated with decreased odds for all complications and resource utilizations outcomes. Further research is needed to determine the association between neuraxial use and improved outcomes in comparison to general anesthesia.

  • neuraxial anesthesia
  • general anesthesia
  • postoperative outcomes

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