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Regional anesthesia and acute pain
Comparative effectiveness of neuraxial versus general anesthesia in total joint replacement surgery: an updated retrospective analysis using more recent data
  1. Alex Illescas1,
  2. Crispiana Cozowicz2,
  3. Haoyan Zhong1,
  4. Lisa Reisinger1,2,
  5. Jiabin Liu1,
  6. Jashvant Poeran1,3 and
  7. Stavros G Memtsoudis1,2,4
  1. 1Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
  2. 2Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria
  3. 3Departments of Orthopaedics / Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  4. 4Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA
  1. Correspondence to Dr Stavros G Memtsoudis, Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, NY 10021, USA; memtsoudiss{at}hss.edu

Abstract

Introduction Over a decade ago, our study group showed improved outcomes among total hip/knee arthroplasty (THA/TKA) patients given neuraxial versus general anesthesia. As the use of neuraxial anesthesia has increased and anesthesia practices evolve, updated analyses are critical to ensure if previously found differences still persist.

Methods This retrospective cohort study included elective THA/TKAs from 2006 to 2021 as recorded in the all-payor Premier Healthcare Database. Multivariable regression models measured the association between anesthesia type (neuraxial, general, combined) and several adverse outcomes (pulmonary embolism, cerebrovascular events, pulmonary compromise, cardiac complications, acute myocardial infarction, pneumonia, all infections, acute renal failure, gastrointestinal complications, postoperative mechanical ventilation, intensive care unit admissions, and blood transfusions); models were run separately by period (2006–2015 and 2016–2021) and THA/TKA.

Results We identified 587,919 and 499,484 THAs for 2006–2015 and 2016–2021, respectively; this was 1,186,483 and 803,324 for TKAs. Among THAs, neuraxial anesthesia use increased from 10.7% in 2006 to 25.7% in 2021; during both time periods, specifically neuraxial versus general anesthesia was associated with lower odds for most adverse outcomes, with sometimes stronger (protective) effect estimates observed for 2016–2021 versus 2006–2015 (eg, acute renal failure OR 0.72 CI 0.65 to 0.80 vs OR 0.56 CI 0.50 to 0.63 and blood transfusion OR 0.91 CI 0.89 to 0.94 vs OR 0.44 CI 0.41 to 0.47, respectively; all p<0.001). Similar patterns existed for TKAs.

Conclusion These findings re-confirm our study group’s decade-old study using more recent data and offer additional evidence toward the sustained benefit of neuraxial anesthesia in major orthopedic surgery.

  • REGIONAL ANESTHESIA
  • Lower Extremity
  • Outcome Assessment, Health Care

Data availability statement

Data may be obtained from a third party and are not publicly available.

https://doi.org/10.1136/rapm-2024-105438

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    Data availability statement

    Data may be obtained from a third party and are not publicly available.

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    Footnotes

    • X @jbLiujb, @jashvant_p, @sgmemtsoudis

    • Contributors AI: Performed the statistical analysis, helped conduct the study and write the manuscript, and approved the final manuscript. HZ: Performed the statistical analysis, helped conduct the study and write the manuscript, and approved the final manuscript. JL: Helped design and conduct the study, analyze the data, write the manuscript, and approved the final manuscript. LR: Helped design and conduct the study, analyze the data, write the manuscript, and approved the final manuscript. CC contribution: Helped design and conduct the study, analyze the data, write the manuscript, and approved the final manuscript. JP: Helped design and conduct the study, analyze the data, write the manuscript, and approved the final manuscript. SGM (guarantor): Helped design and conduct the study, analyze the data, write the manuscript, and approved the final manuscript.

    • Funding This work was supported by the Research and Education Fund, Department of Anesthesiology, Critical Care & Pain, Hospital for Special Surgery.

    • Competing interests SGM has a US patent application for a Multicatheter Infusion System (US-2017-0361063) and is the owner of SGM Consulting, LLC. He is a partner in Parvizi Surgical Innovations, LLC.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.