title: Does Neuraxial Anesthesia Decrease Transfusion Rates Following Total Hip Arthroplasty?
abstract: Perioperative transfusions increase complications and cost following THA. Current series evaluating neuraxial anesthesia and blood loss following THA are small and utilize heterogeneous populations. Using the NSQIP database we compared transfusion rates following THA with neuraxial and general anesthesia. Between 2005 and 2012, 28,857 THAs (11,317 neuraxial anesthesia) were identified. Univariate analysis showed lower rates of transfusion, pneumonia, unplanned intubation, prolonged intubation, stroke, all complications, and medical complications in the neuraxial group. Operative time and length of stay were shorter with neuraxial anesthesia as well. After adjusting for patient comorbidities, a multivariate regression model showed fewer transfusions with neuraxial anesthesia. The multivariate regression model showed additional independent risk factors for transfusion including gender, operative time, elevated INR, and a history of hypertension, metastatic cancer, and renal failure.
authors.affiliation: Department of Orthopaedic Surgery, Rush University, Chicago, Illinois.
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Haughom
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.
authors.forename: William W
authors.initials: WW
authors.lastname: Schairer
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.
authors.forename: Benedict U
authors.initials: BU
authors.lastname: Nwachukwu
authors.affiliation: Department of Orthopaedic Surgery, Rush University, Chicago, Illinois.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hellman
authors.affiliation: Department of Orthopaedic Surgery, Rush University, Chicago, Illinois.
authors.forename: Brett R
authors.initials: BR
authors.lastname: Levine
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods*; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D019934:International Normalized Ratio; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications; D061646:Operative Time; D011014:Pneumonia; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States
keywords: NSQIP; epidural; neuraxial anesthesia; spinal; total hip arthroplasty; transfusion