Comparative perioperative outcomes associated with neuraxial versus general anesthesia for simultaneous bilateral total knee arthroplasty.
OBJECTIVE
The influence of the type of anesthesia on perioperative outcomes after bilateral total knee arthroplasty (BTKA) remains unknown. Therefore, we examined a large sample of BTKA recipients, hypothesizing that neuraxial anesthesia would favorably impact on outcomes.


METHODS
We identified patient entries indicating elective BTKA between 2006 and 2010 in a national database; subgrouped them by type of anesthesia: general (G), neuraxial (N), or combined neuraxial-general (NG); and analyzed differences in demographics and perioperative outcomes.


RESULTS
Of 15,687 identified procedures, 6.8% (n = 1066) were performed under N, 80.1% (n = 12,567) under G, and 13.1% (n = 2054) under NG. Comparing N to G and NG, patients in group N were, on average, younger (63.9, 64.6, and 64.8 years; P = 0.030) but did not differ in overall comorbidity burden. Patients in group N required blood product transfusions significantly less frequently (28.5%, 44.7%, 38.0%; P < 0.0001). In-hospital mortality, 30-day mortality, and complication rates tended to be lower in group N, without reaching statistical significance. After adjusting for covariates, N and NG were associated with 16.0% and 6.0% reduction in major complications compared with G, but only the reduced odds for the requirement of blood transfusions associated with N reached statistical significance (N vs G: odds ratio, 0.52 [95% CI, 0.45-0.61], P < 0.0001; NG vs G: odds ratio, 0.77 [95% CI, 0.69-0.86], P < 0.0001).


CONCLUSIONS
Neuraxial anesthesia for BTKA is associated with significantly lower rates of blood transfusions and, by trend, decreased morbidity. Although by itself the effect may be limited, N might be used within a multimodal approach to reduce complications after BTKA.
Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY 10021, USA.
Ottokar
O
Stundner
Ya-Lin
YL
Chiu
Xuming
X
Sun
Madhu
M
Mazumdar
Peter
P
Fleischut
Lazaros
L
Poultsides
Peter
P
Gerner
Gerhard
G
Fritsch
Stavros G
SG
Memtsoudis
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D019645:Arthroplasty, Replacement, Knee; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D012121:Respiration, Artificial / Q000706:statistics & numerical data