Spinal Compared with General Anesthesia in Contemporary Primary Total Hip Arthroplasties.

Autor:	Owen AR; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota., Amundson AW; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota., Fruth KM; Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota., Duncan CM; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota., Smith HM; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota., Johnson RL; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota., Taunton MJ; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota., Pagnano MW; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota., Berry DJ; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota., Abdel MP; Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Jazyk:	angličtina
Zdroj:	The Journal of bone and joint surgery. American volume [J Bone Joint Surg Am] 2022 Sep 07; Vol. 104 (17), pp. 1542-1547. Date of Electronic Publication: 2022 Jun 17.
DOI:	10.2106/JBJS.22.00280
Abstrakt:	Background: The specific advantages of spinal anesthesia compared with general anesthesia for primary total hip arthroplasty (THA) remains unknown. Therefore, this study aimed to investigate the pain control, length of stay, and postoperative outcomes associated with spinal anesthesia compared with general anesthesia in a large cohort of primary THAs from a single, high-volume academic institution. Methods: We retrospectively identified 13,730 primary THAs (11,319 patients) from 2001 to 2016 using our total joint registry. Of these cases, 58% had general anesthesia and 42% had spinal anesthesia. The demographic characteristics were similar between groups, with mean age of 64 years, 51% female, and mean body mass index (BMI) of 31 kg/m 2 . Data were analyzed using an inverse probability of treatment weighted model based on a propensity score that accounted for numerous patient and operative factors. The mean follow-up was 6 years. Results: Patients treated with spinal anesthesia had lower Numeric Pain Rating Scale (NPRS) scores (p < 0.001) and required fewer postoperative oral morphine equivalents (OMEs) at all time points evaluated (p < 0.001). Patients treated with spinal anesthesia also had shorter hospital length of stay (p = 0.02), fewer altered mental status events (odds ratio [OR], 0.7; p = 0.02), and fewer intensive care unit (ICU) admissions (OR, 0.7; p = 0.01). There was no difference in the incidence of deep vein thrombosis (p = 0.8), pulmonary embolism (p = 0.4), 30-day readmissions (p = 0.17), 90-day readmissions (p = 0.18), all-cause revisions (p = 0.17), or all-cause reoperations (p = 0.14). Conclusions: In this large, single-institution study, we found that spinal anesthesia was associated with reduced pain scores and OME use postoperatively. Furthermore, spinal anesthesia resulted in fewer altered mental status events and ICU admissions. These data favor the use of spinal anesthesia in primary THAs. Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence. Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/H95 ). (Copyright © 2022 by The Journal of Bone and Joint Surgery, Incorporated.)
Databáze:	MEDLINE
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