Primary ArthroplastyThe Effect of Neuraxial Anesthesia on Postoperative Outcomes in Total Joint Arthroplasty With Rapid Recovery Protocols
Section snippets
Materials and Methods
Institutional review board approval was obtained. A retrospective chart review was performed for a consecutive series of primary unilateral TJA performed between July 2015 and June 2018. Surgeries were performed by 1 of 13 board-certified orthopedic surgeons at a single institution. All surgeries were conducted post-implementation of a standardized institutional rapid recovery protocol which remained constant over the study period. Data were collected via an administrative database for patient
Results
In total, 2896 patients (49.0%) received GA and 3018 (51.0%) received NA. Over the study time period, the proportion of patients receiving NA increased from 43.3% in 2015 to 56.2% in 2018. When examining TKA and THA patients separately (Table 1), patients receiving NA had a lower BMI (THA: GA 30.43 vs NA 29.13 kg/m2, P < .001; TKA: GA 33.14 vs NA 31.44, kg/m2, P < .001) and a lower percentage of ASA 3 or 4 (THA: GA 47.0% vs NA 30.6%, P < .001; TKA: GA 50.2% vs NA 38.7%, P < .001). TKA patients
Discussion
THA and TKA are typically successful and most patients report improved pain, quality of life, and physical and mental health following recovery from these procedures [[17], [18], [19]]. In part because of this success, the number of these surgeries performed annually continues to increase, necessitating that the healthcare system builds on prior improvements in quality of care and cost containment efforts associated with surgical intervention. Decreasing LOS, increasing home discharge, and
Conclusion
NA appears to contribute to decreased LOS, decreased short-term complications, and decreased transfusions while facilitating home discharge in patients undergoing TKA and THA. These trends are consistent when controlling for patient-specific risk factors, suggesting NA may enhance outcomes for patients with increased age, BMI, and comorbid conditions undergoing TJA. Increased utilization of NA may improve patient outcomes and decrease costs associated with these procedures and should be
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Neuraxial Anesthesia in Patients With Aortic Stenosis: A Systematic Review
2024, Journal of Cardiothoracic and Vascular AnesthesiaSpinal Versus General Anesthesia in Contemporary Revision Total Knee Arthroplasties
2023, Journal of ArthroplastySpinal Versus General Anesthesia in Total Knee Arthroplasty: Are There Differences in Complication and Readmission Rates?
2023, Journal of ArthroplastyCitation Excerpt :The difference in the magnitude of the effect sizes observed between our study and the study by Warren et al. may be related to the longer 90-day follow-up period assessed in the present study. While the current study did not assess postoperative medical and surgical complications, several contemporary studies assessing differences in complication rates between TKA patients receiving spinal and general anesthesia have found favorable results among patients receiving spinal anesthesia [12,21,29,30]. Pugely et al. assessed 14,052 primary TKA patients of which 6,030 (42.9%) underwent spinal anesthesia and 8,022 (57.1%) received general anesthesia [12].
Outcomes and Cost Analysis of a Surgical Care Unit for Outpatient Total Joint Arthroplasties Performed at a Tertiary Academic Center
2022, Arthroplasty TodayCitation Excerpt :This initiative restructured the hospital reimbursement model for TJAs and placed a greater emphasis on value-based care. Hospital systems and orthopedic institutions responded to this change by implementing clinical care pathways geared toward reducing hospital length of stay (LOS) and overall cost of care [4–9]. These pathways have proved successful while maintaining patients' safety as well as clinical and patient-reported outcomes.
All work was performed at Anne Arundel Medical Center, Annapolis, MD.
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2019.11.037.