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Purpose To determine whether combining spinal or epidural anesthesia with general anesthesia (combined anesthesia) reduces major medical complications of elective surgery compared with general anesthesia alone. Methods We conducted a propensity-matched population-based historical cohort study using large healthcare databases from Ontario, Canada. We identified patients undergoing 21 different elective procedures that were amenable to either combined anesthesia or general anesthesia alone in 108 hospitals from 2004 to 2011. We assessed the following four outcomes together as a composite and individually in the 30 days following surgery: acute kidney injury, stroke, myocardial infarction, and all-cause mortality. Results Prior to matching, we identified 21,701 patients receiving general anesthesia and 8,042 patients receiving combined anesthesia. After matching, our cohort included Author contributions Danielle M. Nash, Reem A. Mustafa, Sumit Sharan, and Amit X. Garg helped design the study. Duminda N. Wijeysundera contributed to the study design by suggesting operations to focus on and administrative codes/variables to use for the study. J. Michael Paterson contributed to the study design by suggesting administrative codes to use for anesthesia type. Christopher Vinden contributed to the study design by suggesting administrative codes to use to identify epidural insertions. Ron Wald contributed to the study design by providing clinical expertise regarding acute kidney injury. Blayne Welk contributed to the study design by suggesting the additional outcome of length of stay. P.J. Devereaux contributed to the study design by adding clinical expertise regarding cardiovascular events. Reem A. Mustafa developed the preliminary protocol, and Danielle M. Nash completed the study protocol. Danielle M. Nash, Reem A. Mustafa, Eric McArthur, Duminda N. Wijeysundera, J. Michael Paterson, Christopher Vinden, Ron Wald, Blayne Welk, P.J. Devereaux, and Amit X. Garg contributed to the interpretation of results. Daniel I. Sessler contributed to the interpretation of results particularly regarding discussion about intraoperative vs postoperative anesthesia use. Michael Walsh contributed to the interpretation of results particularly regarding the limitations of the study. Sumit Sharan contributed to the interpretation of the results through a dialogue regarding standard practice for epidural catheter insertions. Danielle M. Nash initiated and finalized the manuscript. 123Can J Anesth/J Can Anesth (2015) 62:356-368 DOI 10.1007 12,379 patients. Twenty-eight baseline characteristics were well-matched between the combined (n = 4,773) and general anesthesia groups (n = 7,606 Conclusion L'ajout de la rachianesthésie ou de l'anesthésie péridurale à l'anesthésie générale n'a pas été associé à une diminution du risque de complications médicales majeures pour 21 procédures chirurgicales électives différentes par rapport à l'anesthésie générale administrée seule.Neuraxial anesthesia (epidural and spinal anesthesia) is widely used f...

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