Perioperative Comparative Effectiveness of Anesthetic Technique in Orthopedic Patients

Stavros G. Memtsoudis; Xuming Sun; Ya-Lin Chiu; Ottokar Stundner; Spencer S. Liu; Samprit Banerjee; Madhu Mazumdar; Nigel E. Sharrock

doi:10.1097/aln.0b013e318286061d

journal article May 01, 2013

Perioperative Comparative Effectiveness of Anesthetic Technique in Orthopedic Patients

Stavros G. Memtsoudis Xuming Sun

Ya-Lin Chiu Ottokar Stundner Spencer S. Liu Samprit Banerjee Madhu Mazumdar Nigel E. Sharrock

Anesthesiology Vol. 118 No. 5 pp. 1046-1058 · Ovid Technologies (Wolters Kluwer Health)

View at Publisher Save 10.1097/aln.0b013e318286061d

Abstract

Abstract

Background
The impact of anesthetic technique on perioperative outcomes remains controversial. We studied a large national sample of primary joint arthroplasty recipients and hypothesized that neuraxial anesthesia favorably influences perioperative outcomes.

Methods
Data from approximately 400 hospitals between 2006 and 2010 were accessed. Patients who underwent primary hip or knee arthroplasty were identified and subgrouped by anesthesia technique: general, neuraxial, and combined neuraxial–general. Demographics, postoperative complications, 30-day mortality, length of stay, and patient cost were analyzed and compared. Multivariable analyses were conducted to identify the independent impact of choice of anesthetic on outcomes.

Results

Of 528,495 entries of patients undergoing primary hip or knee arthroplasty, information on anesthesia type was available for 382,236 (71.4%) records. Eleven percent were performed under neuraxial, 14.2% under combined neuraxial–general, and 74.8% under general anesthesia. Average age and comorbidity burden differed modestly between groups. When neuraxial anesthesia was used, 30-day mortality was significantly lower (0.10, 0.10, and 0.18%;
P
< 0.001), as was the incidence of prolonged (>75th percentile) length of stay, increased cost, and in-hospital complications. In the multivariable regression, neuraxial anesthesia was associated with the most favorable complication risk profile. Thirty-day mortality remained significantly higher in the general compared with the neuraxial or neuraxial–general group for total knee arthroplasty (adjusted odds ratio [OR] of 1.83, 95% CI 1.08–3.1,
P
= 0.02; OR of 1.70, 95% CI 1.06–2.74,
P
= 0.02, respectively).

Conclusions

The utilization of neuraxial
versus
general anesthesia for primary joint arthroplasty is associated with superior perioperative outcomes. More research is needed to study potential mechanisms for these findings.

Topics

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Metrics

415

Citations

24

References

Details

Published: May 01, 2013
Vol/Issue: 118(5)
Pages: 1046-1058

Authors

S

Stavros G. Memtsoudis

Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY; and

N

Nigel E. Sharrock

Cite This Article

Stavros G. Memtsoudis, Xuming Sun, Ya-Lin Chiu, et al. (2013). Perioperative Comparative Effectiveness of Anesthetic Technique in Orthopedic Patients. Anesthesiology, 118(5), 1046-1058. https://doi.org/10.1097/aln.0b013e318286061d

Perioperative Comparative Effectiveness of Anesthetic Technique in Orthopedic Patients

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