Neuraxial and general anesthesia for outpatient total joint arthroplasty result in similarly low rates of major perioperative complications: a multicentered cohort study

Edward Yap, Julia Wei, Christopher Webb, Kevin Ng, Matthias Behrends, Edward Yap, Julia Wei, Christopher Webb, Kevin Ng, Matthias Behrends

Abstract

Background: Neuraxial anesthesia when compared with general anesthesia has shown to improve outcomes following lower extremity total joint arthroplasty. It is unclear whether these benefits are present in outpatient surgery given the selection of healthier patients.

Objective: To compare the effects of neuraxial versus general anesthesia on outcomes following ambulatory hip and knee arthroplasty.

Methods: Multicentered retrospective cohort study in ambulatory hip or knee arthroplasty patients between January 2017 and December 2019. Primary endpoint examined 30-day major postoperative complications (mortality, myocardial infarction, deep venous thromboembolism, pulmonary embolism, stroke, and acute renal failure).

Results: Of 11 523 eligible patients identified, 10 003 received neuraxial anesthesia, while 1520 received general anesthesia. 30-day major complications did not differ between neuraxial anesthesia and general anesthesia groups (1.8% vs 2.3%; aOR=0.85, CI: 0.56 to 1.27, p=0.39). There was no difference in 30-day minor complications (surgical site infection, pneumonia, urinary tract infection; 3.3% vs 4.1%; aOR=0.83, CI: 0.62 to 1.14, p=0.23). The neuraxial group demonstrated reduced pain and analgesia requirements and had less postoperative nausea and vomiting (PONV). Median recovery room length of stay was shorter by 52 min in the general anesthesia group, but these patients were more likely to fail same day discharge (33% vs 23.4%; p<0.01).

Conclusion: Anesthesia type was not associated with an increased risk for complications. However, neuraxial anesthesia improved outcomes that predict readiness for discharge: patients had less pain, required less opioids, and had a lower incidence of PONV, thus improving the rate of same day discharge.

Trial registration number: NCT04203732.

Keywords: ambulatory care; health care; outcome assessment; pain; postoperative; postoperative complications; treatment outcome.

Conflict of interest statement

Competing interests: None declared.

© American Society of Regional Anesthesia & Pain Medicine 2022. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.

Figures

Figure 1
Figure 1
Adjusted OR of 30-day postoperative outcomes for outpatient total knee and hip arthroplasty. ASA, American Society of Anesthesiologists; BMI, body mass index; PE, pulmonary embolism; VTE, venous thromboembolism.

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