title: Neuraxial anesthesia improves long-term survival after total joint replacement: a retrospective nationwide population-based study in Taiwan.
abstract: BACKGROUND
  This study explored the effects of general (GA) and neuraxial (NA) anesthesia on the outcomes of primary total joint replacement (TJR) in terms of postoperative mortality, length of stay (LOS), and hospital treatment costs.
  
  
  METHODS
  From 1997 to 2010, this nationwide population-based study retrospectively evaluated 7,977 patients in Taiwan who underwent primary total hip or knee replacement. We generated two propensity-score-matched subgroups, each containing an equal number of patients who underwent TJR with either GA or NA.
  
  
  RESULTS
  Of the 7,977 patients, 2,990 (37.5%) underwent GA and 4,987 (62.5%) underwent NA. Propensity-score matching was used to create comparable GA and NA groups adjusted for age, sex, comorbidities, surgery type, hospital volume, and surgeon volume. Survival over the first three years following surgery was similar. The proportion of patients alive up to 14 years postoperatively for those undergoing NA was 58.2% (95% confidence interval [CI] 50.4 to 66.0), and for those undergoing GA it was 57.3% (95% CI 51.4 to 63.2). Neuraxial anesthesia was associated with lower median [interquartile range; IQR] hospital treatment cost ($4,079 [3,805-4,444] vs $4,113 [3,812-4,568]; P < 0.001) and shorter median [IQR] LOS (8 [7-10] days vs 8 [6-10] days, respectively; P = 0.024).
  
  
  CONCLUSIONS
  Our results support the use of NA for primary TJR. The improvements in hospital costs persist even when anesthesia costs are removed. The mechanism underlying the association between NA and long-term survival is unknown.
authors.affiliation: Department of Anesthesiology, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Wei-Hung
authors.initials: WH
authors.lastname: Chen
authors.forename: Kuo-Chuan
authors.initials: KC
authors.lastname: Hung
authors.forename: Ping-Heng
authors.initials: PH
authors.lastname: Tan
authors.forename: Hon-Yi
authors.initials: HY
authors.lastname: Shi
mesh_terms: D000368:Aged; D000765:Anesthesia, Conduction / Q000191:economics / Q000379:methods*; D000768:Anesthesia, General / Q000191:economics / Q000379:methods*; D019644:Arthroplasty, Replacement, Hip / Q000191:economics / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D057216:Propensity Score; D012189:Retrospective Studies; D015996:Survival Rate; D013624:Taiwan