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

Abstract

BackgroundNeuraxial 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.ObjectiveTo compare the effects of neuraxial versus general anesthesia on outcomes following ambulatory hip and knee arthroplasty.MethodsMulticentered 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).ResultsOf 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).ConclusionAnesthesia 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 numberNCT04203732.

Complications after outpatient total joint arthroplasty with neuraxial versus general anesthesia: an infographic

“…Whether these benefits are observed in outpatient total joint arthroplasty is not known. In this multicenter retrospective cohort study of 11 523 patients in the Kaiser Permanente system in California by Yap et al ,1 no difference was found in the rate of 30-day major complications, which included mortality, myocardial infarction, deep vein thrombosis, pulmonary embolism, stroke, and acute renal failure, for neuraxial versus general anesthesia groups (1.8% vs 2.3%, adjusted OR=0.85, 95% CI 0.56 to 1.27, p=0.39). While patients who had neuraxial anesthesia reported less pain and nausea and vomiting after surgery, patients who had general anesthesia had shorter recovery room stays.…”

Regional versus general anesthesia for ambulatory total hip and knee arthroplasty

“…Studies in ambulatory TJA have been more equivocal. One retrospective analysis of 11 523 ambulatory TJA patients found no difference in major or minor complications between those who received GA and NA [12 ▪▪ ]. The neuraxial group did, however, report lower pain ratings in the postanesthesia care unit (PACU), opioid consumption, and postoperative nausea and vomiting (PONV) and were less likely to fail same-day discharge.…”

Same-Day Outpatient Lower-Extremity Joint Replacement

“…The benefits of neuraxial anesthesia relative to general are highlighted in Table III, 32,33 . In the hospital outpatient setting for TJA, neuraxial anesthesia was associated with reduced pain, decreased analgesic requirements, less postoperative nausea and vomiting (PONV), and decreased median recovery room length of stay relative to general anesthesia 34 . Given previously identified benefits, it is generally recommended to use neuraxial (specifically spinal) anesthesia, although this has not specifically been studied in the ASC setting.…”