Spinal Anesthesia Is a Viable Option for Revision THA in Selected Patients
Key findings
- This propensity-matched analysis compared 274 patients who received spinal anesthesia during revision of total hip arthroplasty with 274 patients who received general anesthesia
- The general anesthesia group had greater blood loss and longer hospital stay along with greater odds of perioperative transfusion, two or more inpatient complications and discharge to inpatient rehabilitation
- There were no significant differences between groups in readmission rates, total rates of postdischarge complications, rates of individual complications or 90-day mortality
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Patients who receive spinal anesthesia during primary total joint arthroplasty have fewer postoperative complications and less need for blood transfusions compared with those who receive general anesthesia, according to several studies. Similar findings have been reported for the use of spinal versus general anesthesia in the revision of total knee arthroplasty.
Georges Bounajem, MD, former arthroplasty fellow, Stephen Maier, MD, Harvard combined orthopaedic resident, Young-Min Kwon, MD, PhD, program director of the Adult Reconstructive Surgery Fellowship Program and director of the Bioengineering Laboratory in the Department of Orthopaedic Surgery at Massachusetts General Hospital, and colleagues have now become the first to document similar benefits of spinal anesthesia in revision total hip arthroplasty (THA). Their report appears in the Journal of the American Academy of Orthopaedic Surgeons.
Study Methods
The team retrospectively evaluated data on 2,202 patients who had revision THA. Since the study wasn't randomized, the researchers used propensity-score-adjusted multivariate logistic regression analyses to match the spinal anesthesia and general anesthesia groups on age, gender, body mass index, ASA score, Charlson comorbidity index, indications for THA revision and number of surgeons.
The groups were also statistically similar in race/ethnicity, laterality, preoperative inflammatory markers and average follow-up time.
Perioperative Outcomes
Compared with the spinal anesthesia group, the general anesthesia group had:
- Longer average surgical time (161 vs. 175 minutes, P<0.001)
- Greater higher intraoperative (306 vs. 403 mL, P <0.001) and total perioperative blood loss (1,684 vs. 1,808 mL; P<0.001)
- Greater odds of requiring perioperative transfusion (OR, 2.05; P=0.03)
- Greater odds of experiencing two or more inpatient complications (OR, 4.51; P=0.007)
- Longer hospital stay (3.5 vs. 4.3 days; P=0.001)
- Greater odds of discharge to inpatient rehabilitation (OR, 3.14; P=0.003)
Postdischarge Complications
No significant differences between groups were found for:
- 30-, 60- or 90-day readmission rates
- Total rates of major or minor complications
- Rates of individual complications
- 90-day mortality
Re-revisions
Re-revisions for aseptic modes of failure were similar in the two groups (spinal, 11.7%; general, 15.1%). Patients who received general anesthesia were at a higher overall risk of septic failure (OR, 2.20; P=0.045), although there were no significant differences between groups in rates of acute and chronic infection.
Applying the Findings to Practice
The study findings demonstrate that propensity-matched patients who received spinal anesthesia for revision THA exhibited significant reduction in perioperative blood loss, inhospital complications and extended length of stay compared with patients who received general anesthesia, suggesting spinal anesthesia is a viable alternative to general anesthesia in revision THA for selected patients.
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