JANUARY 7, 2025
LAS VEGAS—There remains a need for an optimal anesthetic mode for patients undergoing total joint arthroplasty, whether it is spinal anesthesia (SA) or general anesthesia (GA).
According to new research presented during the 49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting of ASRA Pain Medicine, both methods are viable options for this patient population. However, there is some higher risk for cardiovascular events and mortality within the first year postoperatively for
LAS VEGAS—There remains a need for an optimal anesthetic mode for patients undergoing total joint arthroplasty, whether it is spinal anesthesia (SA) or general anesthesia (GA).
According to new research presented during the 49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting of ASRA Pain Medicine, both methods are viable options for this patient population. However, there is some higher risk for cardiovascular events and mortality within the first year postoperatively for patients in the GA group.
“GA may be associated with higher rates of deep venous thrombosis in [total knee arthroplasty] and pulmonary embolism in [total hip arthroplasty],” the authors wrote. “GA was also loosely associated with increased mortality within 1 year of [total hip arthroplasty], but this result should be considered with caution.”
While GA has traditionally been recommended for this patient group, SA has become more common for elderly patients with comorbidities in recent years.
In the study, the investigators retrospectively reviewed the results of patients undergoing primary total hip or total knee arthroplasty between February 2007 and February 2021, who received either GA (n=2,154) or SA (n=3,152).
The team compared readmission within 90 days, mortality within 365 days, and thromboembolic events 30 days postoperative and employed a multivariate model that was controlled for age, body mass index (BMI), and Charlson Comorbidity Index (CCI).
Overall, the investigators found no differences in the odds of 90-day readmission or pulmonary embolisms between the two groups. On the other hand, patients in the GA group had a better chance of experiencing a deep venous thrombosis (DVT) within 30 days postoperatively in both bivariate (OR, 1.77; 95% CI, 1.24-2.52; P=0.002) and multivariate (OR, 1.66; 95% CI, 1.012.71; P=0.044) analyses. The results also show a higher likelihood of mortality within 365 days postoperatively in the GA group in both bivariate (OR, 2.36; 95% CI, 1.36-4.21; P=0.003) and multivariate (OR, 2.39; 95% CI, 1.00-5.79; P=0.05).
—Kenneth Walter
