title: Is neuraxial anesthesia safe in patients undergoing surgery for treatment of periprosthetic joint infection?
abstract: BACKGROUND
  There is concern that neuraxial anesthesia in patients undergoing surgery for treatment of a periprosthetic joint infection (PJI) may increase the risk of having a central nervous system infection develop. However, the available data on this topic are limited and contradictory.
  
  
  OBJECTIVE
  We wished to determine whether neuraxial anesthesia (1) is associated with central nervous system infections in patients undergoing surgery for a PJI, and (2) increases the likelihood of systemic infection in these patients.
  
  
  METHODS
  All 539 patients who received neuraxial or general anesthesia during 1499 surgeries for PJI from October 2000 to May 2013 were included in this study; of these, 51% (n = 764) of the surgeries were performed in 134 patients receiving neuraxial anesthesia and 49% were performed in 143 patients receiving general anesthesia. Two hundred sixty-two patients received general and neuraxial anesthesia during different surgeries. We used the International Classification of Diseases, 9(th) Revision codes and the medical records to identify patients who had an intraspinal abscess or meningitis develop after surgery for a PJI. Multivariate analysis was used to assess the effect of type of anesthesia (neuraxial versus general) on postoperative complications.
  
  
  RESULTS
  There were no cases of meningitis, but one epidural abscess developed in a patient after neuraxial anesthesia. This patient underwent six revision surgeries during a 42-day period. Patients who received neuraxial anesthesia had lower odds of systemic infections (4% versus 12%; odds ratio, 0.35; 95% CI, 023-054; p < 0.001).
  
  
  CONCLUSIONS
  Central nervous system infections after neuraxial anesthesia in patients with a PJI appear to be exceedingly rare. Based on the findings of this study, it may be time for the anesthesiology community to reevaluate the risk of sepsis as a relative contraindication to the use of neuraxial anesthesia.
authors: Rothman Institute of Orthopaedics, Thomas Jefferson Hospital, Philadelphia, PA, USA.
authors: Mohammad R
authors: MR
authors: Rasouli
authors: Priscilla K
authors: PK
authors: Cavanaugh
authors: Camilo
authors: C
authors: Restrepo
authors: Hasan Huseyin
authors: HH
authors: Ceylan
authors: Hasan Huseyin
authors: HH
authors: Celyan
authors: Mitchell G
authors: MG
authors: Maltenfort
authors: Eugene R
authors: ER
authors: Viscusi
authors: Javad
authors: J
authors: Parvizi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000765:Anesthesia, Conduction; D000768:Anesthesia, General; D002494:Central Nervous System Infections / Q000453:epidemiology*; D002648:Child; D015897:Comorbidity; D000075202:Contraindications; D020802:Epidural Abscess / Q000453:epidemiology; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000601:surgery*; D018570:Risk Assessment; D055815:Young Adult