Published in J Bone Joint Surg Am 2015 Feb 4; 97:e18
Authors: Sharrock NE.
In an observational study, most outcomes favored regional anesthesia.
For patients undergoing total hip arthroplasty, some evidence suggests that perioperative outcomes are more favorable with regional anesthesia than with general anesthesia. To shed additional light on this issue, U.S. researchers accessed a large surgical database that included detailed information on 13,000 total hip arthroplasties. Forty percent of patients received regional anesthesia (mostly spinal), and 60% received general anesthesia; the two groups were compared using propensity matching and multivariable analyses.
Regional anesthesia patients, compared with general anesthesia patients, were significantly less likely to have surgical site infections (3 fewer per 1000 patients), cardiovascular complications (5 fewer per 1000 patients), and respiratory complications (4 fewer per 1000 patients). In addition, those who received regional anesthesia were significantly less likely to stay in the hospital for ≥7 days (5% vs. 7%). Thirty-day mortality was similar in the two groups (about 0.3%).
Comment
Advising patients about anesthesia generally is considered to be within the purview of anesthesiologists and surgeons. Nevertheless, patients sometimes ask their primary care physicians for an opinion on the tradeoffs between general anesthesia and regional anesthesia; this study can inform that discussion for patients undergoing hip replacement surgery. An editorialist — a U.S. anesthesiologist — notes that general anesthesia is used much more commonly in the U.S. than it is in the U.K. for total hip arthroplasty; he urges his American colleagues to emulate U.K. practice.