title: Effects of regional versus general anesthesia on outcomes after total hip arthroplasty: a retrospective propensity-matched cohort study.
abstract: BACKGROUND
  Many orthopaedic surgical procedures can be performed with either regional or general anesthesia. We hypothesized that total hip arthroplasty with regional anesthesia is associated with less postoperative morbidity and mortality than total hip arthroplasty with general anesthesia.
  
  
  METHODS
  This retrospective propensity-matched cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database included patients who had undergone total hip arthroplasty from 2007 through 2011. After matching, logistic regression was used to determine the association between the type of anesthesia and deep surgical site infections, hospital length of stay, thirty-day mortality, and cardiovascular and pulmonary complications.
  
  
  RESULTS
  Of 12,929 surgical procedures, 5103 (39.5%) were performed with regional anesthesia. The adjusted odds for deep surgical site infections were significantly lower in the regional anesthesia group than in the general anesthesia group (odds ratio [OR] = 0.38; 95% confidence interval [CI] = 0.20 to 0.72; p < 0.01). The hospital length of stay (geometric mean) was decreased by 5% (95% CI = 3% to 7%; p < 0.001) with regional anesthesia, which translates to 0.17 day for each total hip arthroplasty. Regional anesthesia was also associated with a 27% decrease in the odds of prolonged hospitalization (OR = 0.73; 95% CI = 0.68 to 0.89; p < 0.001). The mortality rate was not significantly lower with regional anesthesia (OR = 0.78; 95% CI = 0.43 to 1.42; p > 0.05). The adjusted odds for cardiovascular complications (OR = 0.61; 95% CI = 0.44 to 0.85) and respiratory complications (OR = 0.51; 95% CI = 0.33 to 0.81) were all lower in the regional anesthesia group.
  
  
  CONCLUSIONS
  Compared with general anesthesia, regional anesthesia for total hip arthroplasty was associated with a reduction in deep surgical site infection rates, hospital length of stay, and rates of postoperative cardiovascular and pulmonary complications. These findings could have an important medical and economic impact on health-care practice.
authors: Department of Anesthesiology (M.A.H., M.S.A., A.B.A., D.J.K., and H.A.K.), Department of Orthopedic Surgery (J.C.C.), and Department of Surgery (B.L.H.), Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110. E-mail address for M.A. Helwani: helwanim@wustl.edu.
authors: Mohammad A
authors: MA
authors: Helwani
authors: Department of Anesthesiology (M.A.H., M.S.A., A.B.A., D.J.K., and H.A.K.), Department of Orthopedic Surgery (J.C.C.), and Department of Surgery (B.L.H.), Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110. E-mail address for M.A. Helwani: helwanim@wustl.edu.
authors: Michael S
authors: MS
authors: Avidan
authors: Department of Anesthesiology (M.A.H., M.S.A., A.B.A., D.J.K., and H.A.K.), Department of Orthopedic Surgery (J.C.C.), and Department of Surgery (B.L.H.), Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110. E-mail address for M.A. Helwani: helwanim@wustl.edu.
authors: Arbi
authors: A
authors: Ben Abdallah
authors: Department of Anesthesiology (M.A.H., M.S.A., A.B.A., D.J.K., and H.A.K.), Department of Orthopedic Surgery (J.C.C.), and Department of Surgery (B.L.H.), Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110. E-mail address for M.A. Helwani: helwanim@wustl.edu.
authors: Dagmar J
authors: DJ
authors: Kaiser
authors: Department of Anesthesiology (M.A.H., M.S.A., A.B.A., D.J.K., and H.A.K.), Department of Orthopedic Surgery (J.C.C.), and Department of Surgery (B.L.H.), Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110. E-mail address for M.A. Helwani: helwanim@wustl.edu.
authors: John C
authors: JC
authors: Clohisy
authors: Department of Anesthesiology (M.A.H., M.S.A., A.B.A., D.J.K., and H.A.K.), Department of Orthopedic Surgery (J.C.C.), and Department of Surgery (B.L.H.), Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110. E-mail address for M.A. Helwani: helwanim@wustl.edu.
authors: Bruce L
authors: BL
authors: Hall
authors: Department of Anesthesiology (M.A.H., M.S.A., A.B.A., D.J.K., and H.A.K.), Department of Orthopedic Surgery (J.C.C.), and Department of Surgery (B.L.H.), Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110. E-mail address for M.A. Helwani: helwanim@wustl.edu.
authors: Heiko A
authors: HA
authors: Kaiser
mesh_terms: D000368:Aged; D000765:Anesthesia, Conduction / Q000009:adverse effects* / Q000706:statistics & numerical data; D000768:Anesthesia, General / Q000009:adverse effects* / Q000706:statistics & numerical data; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000706:statistics & numerical data; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology