Postoperative outcomes with neuraxial versus general anesthesia in bilateral total hip arthroplasty

Abstract

Study objective: Current evidence remains limited on the postoperative outcomes of neuraxial (NA) versus general anesthesia (GA) as primary anesthesia type in patients receiving simultaneous bilateral total hip arthroplasty (BTHA). We aimed to evaluate the rates of postoperative outcomes among patients receiving NA versus GA for BTHA.

Design: Retrospective cohort study.

Setting: Multi-institutional.

Patients: A total of 798 patients undergoing BTHA with 519 and 279 who received GA and NA, respectively. We used the American College of Surgeons - National Surgical Quality Improvement Program database for years 2007 to 2016.

Interventions: Patients undergoing BTHA.

Measurements: We propensity-score matched on demographic factors and comorbid conditions to compare rates of postoperative outcomes among cohorts (NA versus GA). We performed Pearson chi-square and Wilcoxon rank sum test to compare NA versus GA cohorts.

Main results: The final analysis included 798 BTHA patients, of which 35% received NA as the primary anesthetic. The median age was 58 years old and 50.8% were female. The rate of perioperative transfusion in the NA and GA group were 20.1% and 29.0%, respectively (p = 0.02). There were no significant differences in the rate of postoperative outcomes between patients receiving NA versus GA as their primary anesthesia type (Bonferroni corrected p < 0.006 was considered statistically significant).

Conclusion: Our study showed no significant differences in postoperative outcomes between NA versus GA following BTHA. Further studies are needed to investigate outcomes among this surgical population.

Keywords: ACS NSQIP; Bilateral total hip arthroplasty; Neuraxial anesthesia; Postoperative outcomes.