title: Perioperative comparative effectiveness of anesthetic technique in orthopedic patients.
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.
authors.affiliation: Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA. memtsoudiss@hss.edu
authors.forename: Stavros G
authors.initials: SG
authors.lastname: Memtsoudis
authors.forename: Xuming
authors.initials: X
authors.lastname: Sun
authors.forename: Ya-Lin
authors.initials: YL
authors.lastname: Chiu
authors.forename: Ottokar
authors.initials: O
authors.lastname: Stundner
authors.forename: Spencer S
authors.initials: SS
authors.lastname: Liu
authors.forename: Samprit
authors.initials: S
authors.lastname: Banerjee
authors.forename: Madhu
authors.initials: M
authors.lastname: Mazumdar
authors.forename: Nigel E
authors.initials: NE
authors.lastname: Sharrock
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000768:Anesthesia, General / Q000401:mortality; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D019645:Arthroplasty, Replacement, Knee / Q000379:methods; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D038801:International Classification of Diseases; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019637:Orthopedic Procedures / Q000379:methods* / Q000401:mortality; D019990:Perioperative Care / Q000379:methods*; D012044:Regression Analysis; D016896:Treatment Outcome