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Comparative perioperative outcomes associated with neuraxial versus general anesthesia for simultaneous bilateral total knee arthroplasty.

TitleComparative perioperative outcomes associated with neuraxial versus general anesthesia for simultaneous bilateral total knee arthroplasty.
Publication TypeJournal Article
Year of Publication2012
AuthorsStundner O, Chiu Y-L, Sun X, Mazumdar M, Fleischut P, Poultsides L, Gerner P, Fritsch G, Memtsoudis SG
JournalReg Anesth Pain Med
Date Published2012 Nov-Dec
KeywordsAdult, Age Distribution, Aged, Anesthesia, Epidural, Anesthesia, General, Anesthesia, Spinal, Arthroplasty, Replacement, Knee, Blood Transfusion, Databases, Factual, Female, Hospital Mortality, Humans, Length of Stay, Male, Middle Aged, Multivariate Analysis, Postoperative Complications, Respiration, Artificial

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.

Alternate JournalReg Anesth Pain Med
PubMed ID23080348
PubMed Central IDPMC3653590
Grant ListU18 HSO16-75 / / PHS HHS / United States
UL1 RR024996 / RR / NCRR NIH HHS / United States
UL1-RR024996 / RR / NCRR NIH HHS / United States