PT  - JOURNAL ARTICLE
AU  - Ottokar Stundner
AU  - Ya-Lin Chiu
AU  - Xuming Sun
AU  - Madhu Mazumdar
AU  - Peter Fleischut
AU  - Lazaros Poultsides
AU  - Peter Gerner
AU  - Gerhard Fritsch
AU  - Stavros G. Memtsoudis
TI  - Comparative Perioperative Outcomes Associated With Neuraxial Versus General Anesthesia for Simultaneous Bilateral Total Knee Arthroplasty
AID  - 10.1097/AAP.0b013e31826e1494
DP  - 2012 Nov 01
TA  - Regional Anesthesia & Pain Medicine
PG  - 638--644
VI  - 37
IP  - 6
4099  - http://rapm.bmj.com/content/37/6/638.short
4100  - http://rapm.bmj.com/content/37/6/638.full
SO  - Reg Anesth Pain Med2012 Nov 01; 37
AB  - Background and Objectives The influence of the type of anesthesia on perioperative outcomes after bilateral total knee arthroplasty (BTKA) remains unknown. Therefore, we examined a large sample of BTKA recipients, hypothesizing that neuraxial anesthesia would favorably impact on outcomes.Methods We identified patient entries indicating elective BTKA between 2006 and 2010 in a national database; subgrouped them by type of anesthesia: general (G), neuraxial (N), or combined neuraxial-general (NG); and analyzed differences in demographics and perioperative outcomes.Results Of 15,687 identified procedures, 6.8% (n = 1066) were performed under N, 80.1% (n = 12,567) under G, and 13.1% (n = 2054) under NG. Comparing N to G and NG, patients in group N were, on average, younger (63.9, 64.6, and 64.8 years; P = 0.030) but did not differ in overall comorbidity burden. Patients in group N required blood product transfusions significantly less frequently (28.5%, 44.7%, 38.0%; P < 0.0001). In-hospital mortality, 30-day mortality, and complication rates tended to be lower in group N, without reaching statistical significance. After adjusting for covariates, N and NG were associated with 16.0% and 6.0% reduction in major complications compared with G, but only the reduced odds for the requirement of blood transfusions associated with N reached statistical significance (N vs G: odds ratio, 0.52 [95% CI, 0.45–0.61], P < 0.0001; NG vs G: odds ratio, 0.77 [95% CI, 0.69–0.86], P < 0.0001).Conclusions Neuraxial anesthesia for BTKA is associated with significantly lower rates of blood transfusions and, by trend, decreased morbidity. Although by itself the effect may be limited, N might be used within a multimodal approach to reduce complications after BTKA.