Neuraxial anaesthesia techniques and postoperative outcomes among joint arthroplasty patients: is spinal anaesthesia the best option?

• Published in: British journal of anaesthesia : BJA Vol. 121; no. 4; pp. 842 - 849
• Main Authors: Weinstein, S.M., Baaklini, L.R., Liu, J., Poultsides, L., Cozowicz, C., Poeran, J., Saleh, J.N., Memtsoudis, S.G.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.10.2018
• Subjects: Aged; anaesthesia; Anesthesia, Conduction - methods; Anesthesia, Epidural - methods; Anesthesia, Spinal - methods; arthroplasties; Arthroplasty, Replacement - methods; Arthroplasty, Replacement, Hip - methods; Arthroplasty, Replacement, Knee - methods; Cohort Studies; Female; hip replacement; hospital length of stay; Humans; knee replacement; Length of Stay; Male; Middle Aged; postoperative complications; Postoperative Complications - epidemiology; Retrospective Studies; spinal; Treatment Outcome; hip replacement; knee replacement; spinal; postoperative complications; hospital length of stay; arthroplasties; anaesthesia
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1016/j.bja.2018.05.071

Neuraxial anaesthesia is frequently used for lower limb arthroplasty but it is unclear whether benefits vary among patients receiving different subtypes of neuraxial anaesthesia. We evaluated whether differences in risk for adverse postoperative outcomes exist between patients receiving combined spinal and epidural (CSE), epidural, or spinal anaesthesia. In this retrospective cohort study, we identified 40 852 patients who underwent total hip and knee arthroplasty (THA and TKA) procedures under neuraxial anaesthesia (34 301 CSE, 2464 epidural, 4087 spinal) between 2005 and 2014 at a single institution. We used multivariable logistic regression to evaluate the following outcomes: cardiac, pulmonary, gastrointestinal, renal/genitourinary, and thromboembolic complications, and prolonged length of stay. Compared with CSE, spinal anaesthesia was associated with reduced adjusted odds for cardiac [odds ratio (OR), 0.68; 95% confidence interval (CI), 0.52–0.89], pulmonary (OR: 0.51; 95% CI: 0.38–0.68), gastrointestinal (OR: 0.50; 95% CI: 0.32–0.78), and thromboembolic complications (OR: 0.40; 95% CI: 0.23–0.73), and prolonged length of stay (OR: 0.72; 95% CI: 0.66–0.80). Patients who received epidural anaesthesia did not have significantly different odds for any outcomes compared with CSE patients. We identified clear differences in risk for certain postoperative events by subtype of neuraxial anaesthesia, suggesting that spinal anaesthesia is associated with the most favourable outcomes profile.