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Neuraxial versus general anesthesia for perioperative outcomes and resource utilization following knee arthroplasty: experience from a large national database

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Attentions have been paid to the optimal anesthesia for knee arthroplasty (KA). We sought to investigate whether neuraxial anesthesia (NA) is superior to general anesthesia (GA) in terms of perioperative outcomes and resource utilization following KA.

Methods

Patients undergoing primary KA registered in the Hospital Quality Monitoring System (HQMS) in China during 2013–2019 were identified. By utilizing a time-stratified propensity score matching, every patient receiving NA was matched by propensity score to a patient receiving GA. Then, we conducted Poisson, logistic, and linear regression to compare NA with GA in terms of perioperative outcomes and resource utilization.

Results

Of 109,132 included participants, 75,945 (69.59%) underwent KA with GA and 33,187 (30.41%) with NA. After propensity score matching (26,425 participants per group), NA was associated with lower incidence of blood transfusion (OR: 0.82, 95% CI 0.77–0.87; p < 0.0001), 30-day readmission (OR: 0.76, 95% CI 0.68–0.84; p < 0.0001), and 90-day readmission (OR: 0.83, 95% CI 0.77–0.90; p < 0.0001). No statistically significant difference in in-hospital mortality, incidence of pulmonary embolism, deep vein thrombosis, and surgical site infection was found. In addition, NA was associated with a 1% decrease in length of stay (95% CI 0–2%; p = 0.0070) and a 3% lower total hospital charge (95% CI 2–4%; p < 0.0001) when compared with GA.

Conclusion

Compared with GA, NA was associated with decreased incidence of blood transfusion, readmission, reduced length of stay, and total hospital charge following KA, suggesting the favorable role of NA for perioperative outcomes and resource utilization in KA.

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Funding

This work was supported by the National Natural Science Foundation of China (81930071, 81772413, 81702207), the World Health Organization (WHO Reference 2016/648722–0 and 2017/722356–0 for the China–World Health Organization Biennial Collaborative Projects 2016–2017), the Project Program of National Clinical Research Center for Geriatric Disorders (Xiangya Hospital, 2020LNJJ03), the Science and Technology Program of Hunan Province (2019RS2010), and the Fundamental Research Funds for the Central Universities of Central South University (2019zzts351).

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Authors and Affiliations

  1. Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China

    Huizhong Long, Chao Zeng & Guanghua Lei

  2. Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China

    Chao Zeng & Guanghua Lei

  3. Hunan Engineering Research Center for Osteoarthritis, Changsha, China

    Chao Zeng & Guanghua Lei

  4. National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China

    Chao Zeng & Guanghua Lei

  5. Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China

    Yunchuan Xiong

  6. China Standard Medical Information Research Center, Shenzhen, China

    Ying Shi & Haibo Wang

  7. Clinical Trial Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China

    Haibo Wang

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  1. Huizhong Long
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Correspondence to Guanghua Lei.

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This study was authorized by the HQMS Committee Board and approved by the ethics committee of Xiangya Hospital (reference number: 2017121016), with waiver of informed consent.

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Long, H., Zeng, C., Xiong, Y. et al. Neuraxial versus general anesthesia for perioperative outcomes and resource utilization following knee arthroplasty: experience from a large national database. Arch Orthop Trauma Surg 143, 2153–2163 (2023). https://doi.org/10.1007/s00402-022-04483-5

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