Anesthesia Type Affects Perioperative Outcomes in Orthopedic Surgery Patients

A study published in the May issue of Anesthesiology discovered that spinal or epidural anesthesia, types of regional anesthesia that numb patients from the abdomen to the toes, were associated with fewer postoperative complications and death than general anesthesia in patients undergoing primary hip or knee replacement.

“In the very near future, given the impending changes to the health care system, physicians and health care delivery systems will find themselves scrutinized on quality metrics of how well their patients fare in the perioperative period,” said Jason E. Lang, M.D., assistant professor, Department of Orthopaedic Surgery, Wake Forest University, Winston-Salem, N.C. “This study demonstrates how the ability of surgeons, anesthesiologists and other members of the surgical team  to provide neuraxial anesthesia can positively impact morbidity and mortality surrounding an increasingly common orthopedic procedure.”

Total joint replacements are performed in more than 1 million patients each year in the United States. As Americans age and their life span increases, the need for this type of orthopedic surgery will rise. By 2030, an estimated 3 million patients are expected to undergo total joint replacements annually. To date, the use of spinal or epidural anesthesia in this type of surgery has been highly underutilized and its effect on a wide range of outcomes largely unknown.

To determine whether spinal or epidural anesthesia produces better outcomes than general anesthesia, researchers from Weil Medical College of Cornell University, New York, utilized data collected from approximately 400 U.S. hospitals from 2006 to 2010. Patients who underwent primary hip or knee replacement were sub-grouped by the type of anesthesia they received: general (74.8 percent), spinal or epidural (11 percent), or combined spinal or epidural-general (14.2 percent).

In the 382,236 cases, neuraxial compared to general anesthesia resulted in an:

• 80 percent lower 30-day mortality rate;
• 30 percent lower risk of prolonged length of hospital stay and increased patient costs; and 
• 30 to 50 percent lower risk of major complications including stroke, pneumonia, kidney failure and the need for mechanical ventilation.

“While anesthesia is commonly viewed as a tool to allow surgery to safely take place, the type of anesthesia used may have a far bigger impact on patients’ outcomes than previously assumed,” said study author Stavros George Memtsoudis, M.D., Ph.D. “We believe our data support anesthesiologists’ role far beyond the operating room in decisively affecting perioperative health and economic outcomes.”

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