NEJM Journal Watch
Neil H. Winawer, MD, SFHM, reviewing
Patients who received spinal anesthesia had less pain and opioid use and fewer intensive care admissions.
The optimal choice of anesthesia — spinal or general — often is debated for patients undergoing total hip arthroplasty (THA). Mayo Clinic researchers retrospectively evaluated approximately 14,000 primary THAs (mean patient age, 64; average body-mass index, 31 kg/m2) performed during a 15-year period. General anesthesia was administered in 58% of cases.
Patients who received spinal anesthesia had lower mean pain scores throughout their hospitalizations, along with 26% less opioid use. After adjustment for multiple variables, patients who received spinal anesthesia experienced significantly fewer episodes of altered mental status (odds ratio, 0.7) and required fewer blood transfusions (OR, 0.7) and intensive care admissions (OR, 0.7); however, incidence of postoperative urinary retention was higher (OR, 1.1). Length of stay was not significantly different between groups, and no differences were observed in 30- or 90-day readmissions or 90-day venous thromboembolic events.
Despite its single-center design, this study suggests that spinal anesthesia offers advantages over general anesthesia for primary THA, such as better pain control and fewer postoperative complications. Although preoperative medical consultants traditionally defer anesthesia recommendations, knowing these results should foster proactive discussion with our surgical and anesthesiology colleagues when patient or clinician preferences exist.
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