Huizhong Long1, Chao Zeng1,2,3,4, Yunchuan Xiong5, Ying Shi6, Haibo Wang6,7, Guanghua Lei8,9,10,11. 1. Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China. 2. Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China. 3. Hunan Engineering Research Center for Osteoarthritis, Changsha, China. 4. National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China. 5. Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China. 6. China Standard Medical Information Research Center, Shenzhen, China. 7. Clinical Trial Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China. 8. Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China. lei_guanghua@csu.edu.cn. 9. Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China. lei_guanghua@csu.edu.cn. 10. Hunan Engineering Research Center for Osteoarthritis, Changsha, China. lei_guanghua@csu.edu.cn. 11. National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China. lei_guanghua@csu.edu.cn.
Abstract
INTRODUCTION: Attentions have been paid to the optimal anesthesia for knee arthroplasty (KA). We sought to investigate whether neuraxial anesthesia (NA) is superior to general anesthesia (GA) in terms of perioperative outcomes and resource utilization following KA. METHODS: Patients undergoing primary KA registered in the Hospital Quality Monitoring System (HQMS) in China during 2013-2019 were identified. By utilizing a time-stratified propensity score matching, every patient receiving NA was matched by propensity score to a patient receiving GA. Then, we conducted Poisson, logistic, and linear regression to compare NA with GA in terms of perioperative outcomes and resource utilization. RESULTS: Of 109,132 included participants, 75,945 (69.59%) underwent KA with GA and 33,187 (30.41%) with NA. After propensity score matching (26,425 participants per group), NA was associated with lower incidence of blood transfusion (OR: 0.82, 95% CI 0.77-0.87; p < 0.0001), 30-day readmission (OR: 0.76, 95% CI 0.68-0.84; p < 0.0001), and 90-day readmission (OR: 0.83, 95% CI 0.77-0.90; p < 0.0001). No statistically significant difference in in-hospital mortality, incidence of pulmonary embolism, deep vein thrombosis, and surgical site infection was found. In addition, NA was associated with a 1% decrease in length of stay (95% CI 0-2%; p = 0.0070) and a 3% lower total hospital charge (95% CI 2-4%; p < 0.0001) when compared with GA. CONCLUSION: Compared with GA, NA was associated with decreased incidence of blood transfusion, readmission, reduced length of stay, and total hospital charge following KA, suggesting the favorable role of NA for perioperative outcomes and resource utilization in KA.
INTRODUCTION: Attentions have been paid to the optimal anesthesia for knee arthroplasty (KA). We sought to investigate whether neuraxial anesthesia (NA) is superior to general anesthesia (GA) in terms of perioperative outcomes and resource utilization following KA. METHODS: Patients undergoing primary KA registered in the Hospital Quality Monitoring System (HQMS) in China during 2013-2019 were identified. By utilizing a time-stratified propensity score matching, every patient receiving NA was matched by propensity score to a patient receiving GA. Then, we conducted Poisson, logistic, and linear regression to compare NA with GA in terms of perioperative outcomes and resource utilization. RESULTS: Of 109,132 included participants, 75,945 (69.59%) underwent KA with GA and 33,187 (30.41%) with NA. After propensity score matching (26,425 participants per group), NA was associated with lower incidence of blood transfusion (OR: 0.82, 95% CI 0.77-0.87; p < 0.0001), 30-day readmission (OR: 0.76, 95% CI 0.68-0.84; p < 0.0001), and 90-day readmission (OR: 0.83, 95% CI 0.77-0.90; p < 0.0001). No statistically significant difference in in-hospital mortality, incidence of pulmonary embolism, deep vein thrombosis, and surgical site infection was found. In addition, NA was associated with a 1% decrease in length of stay (95% CI 0-2%; p = 0.0070) and a 3% lower total hospital charge (95% CI 2-4%; p < 0.0001) when compared with GA. CONCLUSION: Compared with GA, NA was associated with decreased incidence of blood transfusion, readmission, reduced length of stay, and total hospital charge following KA, suggesting the favorable role of NA for perioperative outcomes and resource utilization in KA.
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