title: Does the impact of the type of anesthesia on outcomes differ by patient age and comorbidity burden?
abstract: BACKGROUND
  Neuraxial anesthesia may provide perioperative outcome benefits versus general anesthesia in orthopedic surgical patients. As subgroup analyses are lacking, we evaluated the influence of the type of anesthesia on outcomes in patient groups of different age and the presence of cardiopulmonary disease.
  
  
  METHODS
  Data from approximately 500 hospitals in the United States regarding total hip and total knee arthroplasties performed between 2006 and 2012 were accessed. Patients were categorized by age (ie, <65, 65-74, or ≥75 years) as well as the presence of cardiopulmonary disease. Resulting groups were compared with regard to patient, hospital, procedure, and comorbidity-related variables, as well as incidence of major perioperative complications. A multivariable logistic regression analysis was performed to assess the independent influence of the type of anesthesia on complications within each patient subgroup.
  
  
  RESULTS
  We identified 795,135 records of patients who underwent total hip arthroplasty or total knee arthroplasty. The incidence of major complications was highest in the oldest patient group with cardiopulmonary disease (26.1%) and the lowest in the youngest group without cardiopulmonary disease (4.5%).Multivariable logistic regressions showed that neuraxial anesthesia was associated with decreased odds for combined major complications, need for intensive care services, and prolonged length of stay compared with general anesthesia in all patient subgroups. For patients without major cardiopulmonary comorbidities, the positive impact of neuraxial anesthesia increased with increasing age.
  
  
  CONCLUSIONS
  Neuraxial anesthesia is associated with decreased odds for major complications and resource utilization after joint arthroplasty for all patient groups, irrespective of age and comorbidity burden.
authors: From the *Department of Anesthesiology, Hospital for Special Surgery; †Department of Public Health, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, NY; ‡Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD; and §Department of Neurosurgery, University of Freiburg, Freiburg, Germany.
authors: Stavros G
authors: SG
authors: Memtsoudis
authors: Rehana
authors: R
authors: Rasul
authors: Suzuko
authors: S
authors: Suzuki
authors: Jashvant
authors: J
authors: Poeran
authors: Thomas
authors: T
authors: Danninger
authors: Christopher
authors: C
authors: Wu
authors: Madhu
authors: M
authors: Mazumdar
authors: Vassilios
authors: V
authors: Vougioukas
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000379:methods* / Q000639:trends; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015331:Cohort Studies; D015897:Comorbidity; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome