455 C OPYRIGHT Ó 2015
T HE J OURNAL
AND J OINT
S URGERY, I NCORPORATED
General Compared with Spinal Anesthesia for Total Hip Arthroplasty Bryce A. Basques, BS, Jason O. Toy, MD, Daniel D. Bohl, MPH, Nicholas S. Golinvaux, BA, and Jonathan N. Grauer, MD Investigation performed at the Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut
Background: Total hip arthroplasty may be performed under general or spinal anesthesia. The purpose of the current study was to compare perioperative outcomes between anesthetic types for patients undergoing primary elective total hip arthroplasty. Methods: Patients who had undergone primary elective total hip arthroplasty from 2010 to 2012 were identiﬁed from the American College of Surgeons National Surgical Quality Improvement Program database. Operating room times, length of stay, thirty-day adverse events, and readmission were compared between patients who had received general anesthesia and those who had received spinal anesthesia. Propensity-adjusted multivariate analysis was used to control for selection bias and baseline patient characteristics. Results: A total of 20,936 patients who had undergone total hip arthroplasty met inclusion criteria for this study. Of these, 12,752 patients (60.9%) had received general anesthesia and 8184 patients (39.1%) had received spinal anesthesia. On propensity-adjusted multivariate analyses, general anesthesia for total hip arthroplasty was associated with increased operative time (112 minutes [95% conﬁdence interval, 111 to 113 minutes]; p < 0.001) and postoperative room time (15 minutes [95% conﬁdence interval, 14 to 16 minutes]; p < 0.001). General anesthesia was also associated with the occurrence of any adverse event (odds ratio, 1.31 [95% conﬁdence interval, 1.23 to 1.41]; p < 0.001), prolonged postoperative ventilator use (odds ratio, 5.81 [95% conﬁdence interval, 1.35 to 25.06]; p = 0.018), unplanned intubation (odds ratio, 2.17 [95% conﬁdence interval, 1.11 to 4.29]; p = 0.024), stroke (odds ratio, 2.51 [95% conﬁdence interval, 1.02 to 6.20]; p = 0.046), cardiac arrest (odds ratio, 5.04 [95% conﬁdence interval, 1.15 to 22.07]; p = 0.032), any minor adverse event (odds ratio, 1.35 [95% conﬁdence interval, 1.25 to 1.45]; p = 0.001), and blood transfusion (odds ratio, 1.34 [95% conﬁdence interval, 1.25 to 1.45]; p < 0.001). General anesthesia was not associated with any difference in preoperative room time, postoperative length of stay, or readmission. Conclusions: General anesthesia was associated with an increased rate of adverse events and mildly increased operating room times.
Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Peer Review: This article was reviewed by the Editor-in-Chief and one Deputy Editor, and it underwent blinded review by two or more outside experts. It was also reviewed by an expert in methodology and statistics. The Deputy Editor reviewed each revision of the article, and it underwent a ﬁnal review by the Editor-in-Chief prior to publication. Final corrections and clariﬁcations occurred during one or more exchanges between the author(s) and copyeditors.
otal hip arthroplasty is considered one of the most successful orthopaedic procedures, and more than one million operations are performed each year worldwide1. Historically, general anesthesia has been the gold standard for major hip surgery; however, total hip arthroplasty is now commonly being performed under spinal anesthesia2. The optimal anesthetic technique remains debated.
Several studies have shown the relative beneﬁts of neuraxial anesthesia compared with general anesthesia, such as decreased blood loss and need for transfusion, decreased rates of thromboembolic events, and reduced rates of surgical site infection3-8. The majority of these ﬁndings are from small, single-institution studies. There is a need for large, multicenter studies that directly compare perioperative outcomes between
Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a ﬁnancial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to inﬂuence or have the potential to inﬂuence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to inﬂuence or have the potential to inﬂuence what is written in this work. The complete Disclosures of Potential Conﬂicts of Interest submitted by authors are always provided with the online version of the article. Disclaimer: The content of this publication is solely the responsibility of the authors and does not necessarily represent ofﬁcial views of the National Institutes of Health.
J Bone Joint Surg Am. 2015;97:455-61
456 TH E JO U R NA L O F B O N E & JO I N T SU RG E RY J B J S . O RG V O L U M E 97-A N U M B E R 6 M A R C H 18, 2 015 d
G E N E R A L C O M PA R E D W I T H S P I N A L A N E S T H E S I A T O TA L H I P A R T H R O P L A S T Y
TABLE I Patient Demographic Characteristics and Comorbidities
All Patients* (N = 20,936) Overall
General Anesthesia* (N = 12,752)
Spinal Anesthesia* (N = 8184)
Age (yr) Younger than ﬁfty-ﬁve years
Fifty-ﬁve to sixty-four years
Sixty-ﬁve to seventy-four years
Seventy-ﬁve years or older
Male sex BMI