Impact of Neuraxial Versus General Anesthesia on Discharge Destination in Patients Undergoing Primary Total Hip and Total Knee Replacement

Abstract

Background: Total knee replacement (TKR) and total hip replacement (THR) are 2 of the most common orthopedic surgical procedures in the United States. These procedures, with fairly low mortality rates, incur significant health care costs, with almost 40% of the costs associated with post acute care. We assessed the impact of general versus neuraxial anesthesia on discharge destination and 30-day readmissions in patients who underwent total knee and hip replacement in our health system.

Methods: This was a retrospective cohort study of 24,684 patients undergoing total knee or hip replacement in 13 hospitals of a large health care network. Following propensity score matching, we studied the impact of type of anesthetic technique on discharge destination (primary outcome) and postoperative complications including readmissions in 8613 patients who underwent THR and 13,004 patients for TKR.

Results: Our results showed that in patients undergoing THR and TKR, neuraxial anesthesia is associated with higher odds of being discharged from hospital to home versus other facilities compared to general anesthesia (odds ratio [OR] = 1.63, 95% confidence interval [CI], 1.52-1.76; P < .01) and (OR = 1.58, 95% CI, 1.49-1.67; P < .01), respectively.

Conclusions: Our results suggest an association between use of neuraxial anesthesia for total joint arthroplasty and a higher probability of discharge to home and a reduction in readmissions.

Conflict of interest statement

The authors declare no conflicts of interest.

Copyright © 2020 International Anesthesia Research Society.

Figures

Figure 1:

Flowchart of participants from the study included in the final analysis. Abbreviations: THR, Total hip arthroplasty; TKR, Total knee arthroplasty

Figure 2:

Comparison of the distribution of baseline covariates between groups before and after propensity-score adjustment. A. Patients that received primary total hip replacement. B. Patients that received primary total knee replacement Abbreviations: ASA, American Society of Anesthesiologists

Figure 3:

Measurement of primary outcome: Discharge to home with self-care or home health, data is presented in OR (95% CI). A. Patients that received primary total hip replacement B. Patients that received primary total knee replacement Abbreviations: OR, Odds Ratio; CI, Confidence interval; ASA, American Society of Anesthesiologists

Figure 4:

Measurement of secondary outcome: 30-day readmission, data is presented in OR (95% CI). Abbreviations: OR, Odds Ratio; CI, Confidence interval