Morbidity and Mortality Following Total Hip and Knee Arthroplasty with Spinal versus General Anesthesia: A Retrospective Analysis

Samantha Diulus; Carlos Mucharraz; Daniel Schmitt; Nicholas Brown

doi:10.1016/j.arth.2024.04.070

Morbidity and Mortality Following Total Hip and Knee Arthroplasty with Spinal versus General Anesthesia: A Retrospective Analysis

J Arthroplasty. 2024 May 2:S0883-5403(24)00418-2. doi: 10.1016/j.arth.2024.04.070. Online ahead of print.

Authors

Samantha Diulus¹, Carlos Mucharraz², Daniel Schmitt¹, Nicholas Brown¹

Affiliations

¹ Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, Illinois.
² Department of Anesthesiology, University of Colorado, Aurora, Colorado.

PMID: 38703926
DOI: 10.1016/j.arth.2024.04.070

Abstract

Background: Despite the longstanding debate surrounding anesthesia in total joint arthroplasty, an optimal anesthetic mode has yet to be clearly identified. Patients undergoing total joint arthroplasty may be offered spinal anesthesia (SA) or general anesthesia (GA). While the arthroplasty literature has reported differences in postoperative morbidity, the hip fracture literature does not demonstrate the superiority of SA or GA. The purpose of this study was to further investigate this relationship and determine if there is a significant difference in morbidity and mortality between patients undergoing SA compared with those undergoing GA during primary total hip and knee arthroplasty surgery.

Study design: Cohort study; Level of evidence, 3.

Methods: Patients undergoing primary total hip or total knee arthroplasty from February 2007 to February 2021 were retrospectively reviewed. From this population, four cohorts were created: THA/GA (n = 1,266), THA/SA (n = 1,084), TKA/GA (n =882), and THA/SA (n = 2,067). Readmission within 90 days, mortality within 365 days, and thromboembolic events in the postoperative 30 days were compared using logistic regression analysis. The multivariate model controlled for age, body mass index (BMI), and Charlson Comorbidity Index (CCI).

Results: The odds of experiencing a deep venous thrombosis (DVT) within 30 days postoperatively were elevated in the analysis of both the THA/GA (OR [odds ratio] = 3.1; 95% CI [confidence interval]: 1.5 to 7.0; P = 0.004) and the TKA/GA (OR = 1.9; 95% CI: 1.2 to 3.0; P = 0.005) groups. Similarly, the risk of pulmonary embolism (PE) as higher in the THA/GA cohort (OR = 3.9; 95% CI: 1.2 to 17.3; P = 0.04). There were also higher odds of mortality within 365 days postoperatively in THA/GA patients (OR = 4.3; 95% CI: 1.7 to 13.0; P = 0.004). No other differences existed among TKA patients.

Conclusion: Based upon these data, both spinal and general anesthesia are reasonable options for primary total knee arthroplasty with similar risk profiles. However, general anesthesia may be associated with higher rates of DVT in total joint arthroplasty and PE in total hip arthroplasty. General anesthesia was also loosely associated with increased mortality within one year of total hip arthroplasty, but this result should be considered with caution.

Keywords: THA; TKA; Total hip arthroplasty; anesthesia; total joint arthroplasty; total knee arthroplasty.