Anesthesia Methods And Postoperative Outcomes In Total Joint Arthroplasty

Background: For total joint arthroplasty is a surgical intervention in the treatment of end-stage arthritis and other kinds of hip and knee diseases.With the global aging and high obesity rates,the demands for total joint arthroplasty is growing.Numerous studies have shown the patients get more benefits from intraspinal anesthesia than that from general anesthesia in total joint arthroplasty.However,major researches are limited to the European and American countries,and the domestic research is scanty.So,whether the European and American conclusions apply to the Chinese population remains controversial.This retrospective cohort study with propensity score matching assessed the effect of general anesthesia or intraspinal anesthesia on postoperative complications and 30-day mortality in Chinese population undergoing first unilateral total joint arthroplasty.Methods: In this retrospective cohort study,we identified 651 patients who had the first unilateral total arthroplasty procedures under general anesthesia or intraspinal anesthesia between January 1,2014,and July 15,2019 in Osteoarticular and Tumor Surgery of The First Affiliated Hospital of Fujian Medical University.The group was divided into general anesthesia group and intraspinal anesthesia group.The primary outcomes were postoperative complications:(1)length of stay;(2)pulmonary complications(pneumonia,pulmonary infarction,unplanned intubation);(3)sepsis;(4)urinary infection;(5)myocardial infarction;(6)surgical site infection(superficial,deep,and organ space);(7)perioperative blood transfusion;(8)deep venous thrombosis of lower limbs;(9)re-operation;(10)30-day morbidity.Secondary outcomes were economic benefits: hospitalization expenses.We propensity-score matched on demographic data and preoperative complications to compare postoperative outcomes among cohorts.All statistical analyses use IBM SPSS Statistics 25.The measurement data were measured by t test and non-parametric test,and the counting data by Pearson chi-square test and fisher exact probability method.Logistic regression was used to analyze the selection trend of anesthesia methods,and standardized average difference balance test data comparability.Results: Finally,651 patients were taken into consideration in our study.210 patients in the general anesthesia cohort and 441 patients in the intraspinal anesthesia cohort were matched by 1:1 propensity score matching,and 162 patients were eventually enrolled in each cohort.After 1:1 propensity score matching,there was no significant difference in preoperative general information,surgical and anesthetic conditions between general anesthesia cohort and intraspinal anesthesia cohort(all p > 0.05).In addition,this study found that postoperative outcomes: economic benefits such as hospitalization expenses and postoperative complications such as length of stay,pulmonary complications,sepsis,urinary infection,myocardial infarction,surgical site infection,perioperative blood transfusion,deep venous thrombosis of the lower limbs,re-operation and 30-day mortality were no significant difference between the two cohorts(all p > 0.005).Conclusion: This retrospective,propensity score matching study suggests that general anesthesia and intraspinal anesthesia have similar postoperative outcomes in unilateral total joint arthroplasty patients.