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J Knee Surg 2022; 35(04): 345-354
DOI: 10.1055/s-0040-1713776
Original Article

Association of Anesthesia Type with Postoperative Outcome and Complications in Patients Undergoing Revision Total Knee Arthroplasty

Chapman Wei  ‡   *
1   Department of Anesthesiology & Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
,
Arun Muthiah‡   *
1   Department of Anesthesiology & Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
,
Alex Gu 
2   Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York
,
Theodore Quan
1   Department of Anesthesiology & Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
,
Kenneth T. Nguyen
3   New York Institute of Technology College of Osteopathic Medicine, Glen Head, New York
,
Safa C. Fassihi
4   Department of Orthopedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
,
Aaron Z. Chen
5   Weill Cornell Medical College, New York City, New York
,
Richard L. Amdur
6   Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
,
Ryan M. Nunley
7   Department of Orthopedic Surgery, Washington University at St Louis School of Medicine, St. Louis, Missouri
,
Jiabin Liu
8   Department of Anesthesiology, Hospital for Special Surgery, New York City, New York
,
Peter K. Sculco
2   Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York
,
Jeffrey S. Berger
1   Department of Anesthesiology & Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
› Author Affiliations Funding None.
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Abstract

Revision total knee arthroplasty (TKA) is an increasingly common procedure and is effective in treating knee osteoarthritis, but it has higher complication rates than primary TKA. Anesthetic choice poses perioperative risk that has been extensively studied in primary TKA, showing favorable results for regional anesthesia compared with general anesthesia. The impact of anesthetic choice in revision TKAs is not well studied. A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent revision TKAs between 2014 and 2017 were divided into three anesthesia cohorts: (1) general anesthesia, (2) regional anesthesia, and (3) combined general-regional anesthesia. Univariate and multivariate analyses were used to analyze patient characteristics and 30-day postoperative outcomes. Bonferroni correction was applied for post hoc analysis. In total, 8,820 patients were identified. Of whom, 3,192 patients underwent general anesthesia, 3,474 patients underwent regional anesthesia, and 2,154 patients underwent combined anesthesia. After multivariate analyses, regional anesthesia was associated with decreased odds for any complication (p = 0.008), perioperative blood transfusion (p < 0.001), and extended length of stay (p < 0.001) compared with general anesthesia. In addition, regional anesthesia was associated with decreased odds for perioperative blood transfusion (p < 0.001) and extended length of stay (p = 0.006) compared with combined anesthesia. However, following multivariate analysis, regional anesthesia was not associated with decreased odds of wound, pulmonary, renal, urinary tract, thromboembolic, and cardiac complications, and was not associated with return to operating room, extended length of stay, minor and major complications, and mortality. Retrospective analysis of a large surgical database suggests that patients receiving general anesthesia have increased likelihood for developing adverse postoperative outcomes relative to patients receiving regional anesthesia. Prospective and controlled trials should be conducted to verify these findings.

Keywords

knee replacement arthroplasty - joint revision - regional anesthesia - general anesthesia - combined anesthetics

* The authors contributed equally to the work.




Publication History

Received: 15 October 2019

Accepted: 24 May 2020

Article published online:
14 July 2020

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Murphy SL, Lyden AK, Phillips K, Clauw DJ, Williams DA. Subgroups of older adults with osteoarthritis based upon differing comorbid symptom presentations and potential underlying pain mechanisms. Arthritis Res Ther 2011; 13 (04) R135
    CrossrefPubMedGoogle Scholar
  • 2 Lubowitz JH, Appleby D. Cost-effectiveness analysis of the most common orthopaedic surgery procedures: knee arthroscopy and knee anterior cruciate ligament reconstruction. Arthroscopy 2011; 27 (10) 1317-1322
    CrossrefPubMedGoogle Scholar
  • 3 Kurtz SM, Lau E, Ong K, Zhao K, Kelly M, Bozic KJ. Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res 2009; 467 (10) 2606-2612
    CrossrefPubMedGoogle Scholar
  • 4 Thienpont E. Revision knee surgery techniques. EFORT Open Rev 2017; 1 (05) 233-238
    CrossrefPubMedGoogle Scholar
  • 5 Losina E, Thornhill TS, Rome BN, Wright J, Katz JN. The dramatic increase in total knee replacement utilization rates in the United States cannot be fully explained by growth in population size and the obesity epidemic. J Bone Joint Surg Am 2012; 94 (03) 201-207
    CrossrefPubMedGoogle Scholar
  • 6 Singh JA. Epidemiology of knee and hip arthroplasty: a systematic review. Open Orthop J 2011; 5: 80-85
    CrossrefPubMedGoogle Scholar
  • 7 Botney R. Improving patient safety in anesthesia: a success story?. Int J Radiat Oncol Biol Phys 2008; 71 (01) S182-S186
    CrossrefPubMedGoogle Scholar
  • 8 Gaba DM. Anaesthesiology as a model for patient safety in health care. BMJ 2000; 320 (7237): 785-788
    CrossrefPubMedGoogle Scholar
  • 9 Leape LL, Berwick DM, Bates DW. What practices will most improve safety? Evidence-based medicine meets patient safety. JAMA 2002; 288 (04) 501-507
    CrossrefPubMedGoogle Scholar
  • 10 Cozowicz C, Poeran J, Memtsoudis SG. Epidemiology, trends, and disparities in regional anaesthesia for orthopaedic surgery. Br J Anaesth 2015; 115 (Suppl. 02) ii57-ii67
    CrossrefPubMedGoogle Scholar
  • 11 Memtsoudis SG, Sun X, Chiu YL. et al. Perioperative comparative effectiveness of anesthetic technique in orthopedic patients. Anesthesiology 2013; 118 (05) 1046-1058
    CrossrefPubMedGoogle Scholar
  • 12 Pugely AJ, Martin CT, Gao Y, Mendoza-Lattes S, Callaghan JJ. Differences in short-term complications between spinal and general anesthesia for primary total knee arthroplasty. J Bone Joint Surg Am 2013; 95 (03) 193-199
    CrossrefPubMedGoogle Scholar
  • 13 Hu S, Zhang ZY, Hua YQ, Li J, Cai ZD. A comparison of regional and general anaesthesia for total replacement of the hip or knee: a meta-analysis. J Bone Joint Surg Br 2009; 91 (07) 935-942
    CrossrefPubMedGoogle Scholar
  • 14 Macfarlane AJ, Prasad GA, Chan VW, Brull R. Does regional anesthesia improve outcome after total knee arthroplasty?. Clin Orthop Relat Res 2009; 467 (09) 2379-2402
    CrossrefPubMedGoogle Scholar
  • 15 Liodakis E, Bergeron SG, Zukor DJ, Huk OL, Epure LM, Antoniou J. Perioperative complications and length of stay after revision total hip and knee arthroplasties: an analysis of the NSQIP database. J Arthroplasty 2015; 30 (11) 1868-1871
    CrossrefPubMedGoogle Scholar
  • 16 Park YB, Chae WS, Park SH, Yu JS, Lee SG, Yim SJ. Comparison of short-term complications of general and spinal anesthesia for primary unilateral total knee arthroplasty. Knee Surg Relat Res 2017; 29 (02) 96-103
    CrossrefPubMedGoogle Scholar
  • 17 Jans Ø, Jørgensen C, Kehlet H, Johansson PI. Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group. Role of preoperative anemia for risk of transfusion and postoperative morbidity in fast-track hip and knee arthroplasty. Transfusion 2014; 54 (03) 717-726
    CrossrefPubMedGoogle Scholar
  • 18 Park JH, Rasouli MR, Mortazavi SM, Tokarski AT, Maltenfort MG, Parvizi J. Predictors of perioperative blood loss in total joint arthroplasty. J Bone Joint Surg Am 2013; 95 (19) 1777-1783
    CrossrefPubMedGoogle Scholar
  • 19 Memtsoudis SG, Sun X, Chiu YL. et al. Utilization of critical care services among patients undergoing total hip and knee arthroplasty: epidemiology and risk factors. Anesthesiology 2012; 117 (01) 107-116
    CrossrefPubMedGoogle Scholar
  • 20 Basques BA, McLynn RP, Fice MP. et al. Results of database studies in spine surgery can be influenced by missing data. Clin Orthop Relat Res 2017; 475 (12) 2893-2904
    CrossrefPubMedGoogle Scholar
  • 21 Matsen Ko L, Chen AF. Spinal anesthesia: the new gold standard for total joint arthroplasty?. Ann Transl Med 2015; 3 (12) 162
    PubMedGoogle Scholar
  • 22 Memtsoudis SG, Poeran J, Zubizarreta N. et al. Do hospitals performing frequent neuraxial anesthesia for hip and knee replacements have better outcomes?. Anesthesiology 2018; 129 (03) 428-439
    CrossrefPubMedGoogle Scholar