title: Single-Anesthetic Versus Staged Bilateral Total Hip Arthroplasty: A Matched Cohort Study.
abstract: BACKGROUND
  There is debate regarding the role of single-anesthetic versus staged bilateral total hip arthroplasty (THA) for patients with end-stage bilateral osteoarthritis. Studies have shown that single-anesthetic bilateral THA is associated with systemic complications, but there are limited data comparing patient outcomes in a matched setting of bilateral THA.
  
  
  METHODS
  We identified 94 patients (188 hips) who underwent single-anesthetic bilateral THA. Fifty-seven percent of the patients were male. Patients had a mean age of 52.2 years and body mass index of 27.1 kg/m. They were matched 1:1 on the basis of sex, age (±1 year), and year of surgery (±3 years) to a cohort of patients undergoing staged bilateral THA. In the staged group, there was <1 year between procedures (range, 5 days to 10 months). Mean follow-up was 4 years for each group.
  
  
  RESULTS
  Patients in the single-anesthetic group experienced shorter total operating room time and length of stay. There was no difference (hazard ratio [HR] = 0.73, p = 0.50) in the overall revision-free survival in patients undergoing single-anesthetic or staged bilateral THA. The risks of reoperation (HR = 0.69, p = 0.40), complications (HR = 0.83, p = 0.48), and mortality (HR = 0.47, p = 0.10) were similar. Single-anesthetic bilateral THA reduced the total cost of care (by 27%, p = 0.0001).
  
  
  CONCLUSIONS
  In this matched cohort analysis, single-anesthetic bilateral THA was not associated with an increased risk of revision, reoperation, or postoperative complications, while decreasing cost. In our experience, single-anesthetic bilateral THA is a safe procedure that, for certain patients, offers an excellent means to deal with bilateral hip osteoarthritis.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: 1Mayo Clinic, Rochester, Minnesota.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Houdek
authors.forename: Cody C
authors.initials: CC
authors.lastname: Wyles
authors.forename: Chad D
authors.initials: CD
authors.lastname: Watts
authors.forename: Eric R
authors.initials: ER
authors.lastname: Wagner
authors.forename: Rafael J
authors.initials: RJ
authors.lastname: Sierra
authors.forename: Robert T
authors.initials: RT
authors.lastname: Trousdale
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Taunton
mesh_terms: D000328:Adult; D000368:Aged; D000777:Anesthetics / Q000008:administration & dosage* / Q000191:economics; D019644:Arthroplasty, Replacement, Hip / Q000191:economics / Q000379:methods* / Q000534:rehabilitation; D016063:Blood Loss, Surgical; D003365:Costs and Cost Analysis; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects / Q000191:economics; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D015207:Osteoarthritis, Hip / Q000191:economics* / Q000534:rehabilitation / Q000601:surgery; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology; D011475:Prosthesis Failure / Q000009:adverse effects; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000777:Anesthetics