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).
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.
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