TJA can be successfully carried out under general (GA) or spinal anesthesia (SA). The existing literature does not adequately illustrate which technique is optimal. The purpose of this study was to prospectively compare the effects of anesthesia technique on TJA outcomes.
This 2-year prospective observational study was conducted at a single institution where patients receiving primary TJA were consecutively enrolled. Patients were contacted postoperatively to assess for any 90-day complications. The primary outcome of the study was the overall complication rate.
2242 patients underwent THA (n=656; 29.26%) or TKA (n=1586; 70.74%) between 2015 and 2017. Of these procedures, 1325 (59.10%) were carried out under SA and 917 (40.90%) were carried out under GA. Patients in the GA cohort had higher mean CCI scores (0.05 SA vs. 0.09 GA; p < 0.05) and higher average BMI (29.35 SA vs. 30.24 GA; p < 0.05). On multivariate analysis, patients in the SA cohort had a significantly lower overall complication rate relative to their GA counterparts (7.02% vs. 10.14%; OR 0.66; 95% CI 0.49-0.90; p < 0.05). In addition, LOS in the GA cohort was significantly longer (2.43 days (SD 1.62) vs. 2.18 (SD 0.88); p < 0.01) and a larger percentage of GA patients were discharged to a nursing facility (32.28% vs. 25.06%; OR 0.55; 95% CI 0.44-0.70; p < 0.05).
Our study demonstrates that SA for TJA is associated with a decrease in overall complications and healthcare resource utilization.