Total knee replacement (TKR) and total hip replacement (THR) are 2 of the most common orthopedic surgical procedures in the United States. These procedures, with fairly low mortality rates, incur significant health care costs, with almost 40% of the costs associated with post acute care. We assessed the impact of general versus neuraxial anesthesia on discharge destination and 30-day readmissions in patients who underwent total knee and hip replacement in our health system.
This was a retrospective cohort study of 24,684 patients undergoing total knee or hip replacement in 13 hospitals of a large health care network. Following propensity score matching, we studied the impact of type of anesthetic technique on discharge destination (primary outcome) and postoperative complications including readmissions in 8613 patients who underwent THR and 13,004 patients for TKR.
Our results showed that in patients undergoing THR and TKR, neuraxial anesthesia is associated with higher odds of being discharged from hospital to home versus other facilities compared to general anesthesia (odds ratio [OR] = 1.63, 95% confidence interval [CI], 1.52–1.76; P < .01) and (OR = 1.58, 95% CI, 1.49–1.67; P < .01), respectively.
Our results suggest an association between use of neuraxial anesthesia for total joint arthroplasty and a higher probability of discharge to home and a reduction in readmissions.
See Article, p 1375
- Question: Is neuraxial anesthesia associated with patient disposition after hospital discharge?
- Findings: Patients have a higher likelihood of going home after total hip replacement (THR) and total knee replacement (TKR) under neuraxial anesthesia as compared to general anesthesia.
- Meaning: Because post acute care costs compromise ~40% of primary THR and TKR and emphasis is on value-based health care delivery, discharge destination to home becomes a desired goal and neuraxial anesthesia plays a crucial role.