Primary ArthroplastyPostoperative Outcomes Associated With Neuraxial vs General Anesthesia Following Bilateral Total Knee Arthroplasty
Section snippets
Data Collection
Data were obtained from the publicly available dataset, American College of Surgeons NSQIP for the years 2007-2013. This is a multicenter, prospective, outcome-oriented database. Because the database is de-identified, it meets the criteria of the Health Insurance Portability and Accountability Act to protect personal information and was exempt from the consent requirement by our institutional review board. This database contains data from >200 participating hospitals for patients who underwent
Results
There were a total of 2,820,370 cases in NSQIP, of which 81,679 underwent a TKA. From these, a total of 2078 underwent BTKAs during the same surgical encounter. After exclusion, there were 1957 patients included in the final analysis (119 of the original total were removed due to lack of information regarding primary anesthesia type). Table 1 outlines the demographics in both cohorts. Cases performed under GA tended to be longer than those performed under an NA technique (median of 148 vs
Discussion
Using a large national database and including 1957 patients who received BTKA, this study demonstrated that NA was associated with less blood product transfusions and less total number of blood products transfused as compared to GA. Furthermore, there was no difference in preoperative INR, platelet count, hematocrit, or bleeding disorders in both cohorts. However, choice of anesthetic technique had no statistically significant impact on hospital length of stay, deep vein thrombosis, or
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Does spinal anesthesia for total hip or knee arthroplasty entail longer operating room occupancy compared to general anesthesia? Case-control study of 337 spinal versus 243 general anesthesias
2024, Orthopaedics and Traumatology: Surgery and ResearchModern Lower Extremity Bypass Outcomes by Anesthesia Type in the Veteran Population
2022, Annals of Vascular SurgeryCitation Excerpt :Higher rates of pneumonia and pulmonary complications seen in the GA group are likely related to intubation and ventilator use. The higher transfusion requirement in general anesthesia as opposed to NA is seen in several studies 6,7,8,23,24 and again replicated in our study. The patients who underwent NA had lower rates of bleeding disorders at baseline which likely represents a concern for epidural hematoma, a known complication of NA use.
Lower Dosing of Bupivacaine Spinal Anesthesia Is Not Associated With Improved Perioperative Outcomes After Total Joint Arthroplasty
2021, Arthroplasty TodayCitation Excerpt :In addition, SA is preferred at some institutions over GA because of its low cost, reliability, rapid onset, and ideal duration of action for arthroscopy and arthroplasty. These findings suggest that SA not only provides a functional benefit to patients perioperatively but may also serve to preserve health-care resources and minimize unnecessary expenses [10-12]. Over the last few decades, fast-track protocols have been introduced for TJA to reduce hospital LOS without a concurrent increase in complications or readmissions [13].
Impact of body mass index on hemoglobin level and blood transfusion in total knee arthroplasty: A retrospective case control study
2020, Annals of Medicine and SurgeryCitation Excerpt :Our study demonstrated that estimated blood loss was less among patients with Neuraxial (NA) vs general anesthesia (GA). Walker et al. studied postoperative outcomes associated with NA vs GA following bilateral total knee arthroplasty and showed the same result [30]. The mechanism of reduced requirement of blood transfusions in the setting of NA is unclear.
Obesity does not increase blood loss or incidence of immediate postoperative complications during simultaneous total knee arthroplasty: A multicenter study
2020, KneeCitation Excerpt :Previous studies have reported the use of drain increase the transfusion and infection rate and no drain use is safe and acceptable in the setting of primary TKA [30,31]. Third, Walker et al. demonstrated that neuraxial anesthesia was associated with decreased blood transfusion requirements in patients undergoing SBTKA compared with general anesthesia [32]. In addition, Feng et al. found that general anesthesia was associated with a higher risk of cardiac complications [33].
General vs Spinal Anesthesia for Total Joint Arthroplasty: A Single-Institution Observational Review
2020, Journal of Arthroplasty
Author contributions: Jeffrey B. Walker, Patrick L. Nguyen, Ulrich H. Schmidt, and Rodney A. Gabriel helped design the study, conduct the study, and prepare the manuscript. Rodney A. Gabriel collected the data; Jeffrey B. Walker and Rodney A. Gabriel analyzed the data.
Funding support from National Library of Medicine (NLM) training grant number T15LM011271.
No author associated with this paper has disclosed any potential or pertinent conflicts which may be perceived to have impending conflict with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2017.06.028.