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Background: Bilateral total knee arthroplasty (BTKA) procedures are associated with an increased risk of complications when compared with unilateral approaches. In 2006, in an attempt to reduce this risk, our institution implemented selection criteria that specified younger and healthier patients as candidates for BTKA. Questions/Purpose: We sought to investigate the effect of these selection criteria on perioperative outcomes. Methods: In a retrospective cohort study, we used institutional data to identify patients who underwent BTKA between 1998 and 2014. Patients were divided into 2 groups: those who underwent surgery before the 2006 introduction of our selection criteria (1998–2006) and those who underwent surgery after (2007–2014). Groups were compared in terms of demographics, comorbidity burden, and incidence of perioperative complications. Regression analysis was performed, calculating incidence rate ratios to evaluate changes in complication rates. Results: Before the selection criteria were implemented in 2006, patients who underwent BTKA were older and had a higher comorbidity burden. The rate of major complications per 1000 hospital days decreased from 31.5 in 1998 to 7.9 in 2014. A reduction in cardiac complications was the most significant contributor to this decrease in major complications. Conclusion: After stringent criteria for BTKA candidates were implemented at our institution, selection of younger patients with lower comorbidity burden was accompanied by a reduction in the incidence of operative complications. This suggests that introducing such criteria can be associated with a reduction in adverse perioperative outcomes. [ABSTRACT FROM AUTHOR]

To analyze the use of neuraxial techniques in total hip or knee arthroplasty patients who previously underwent lumbar spine surgeries. Retrospective analysis of a national database. U.S. hospitals. Patients undergoing a total hip or knee arthroplasty, stratified by those with a previous lumbar fusion or decompression procedure. Our primary outcome was the use of neuraxial anesthesia; secondary outcomes included combined complications, cardio-pulmonary complications, and prolonged length of stay. Patients with and without a history of a lumbar procedure were compared using mixed-effects regression. Among 758,857 THAs 8961 had a history of lumbar fusion and 8599 of decompression. Among 1,387,335 TKAs 15,827 had a history of lumbar fusion and 13,652 of decompression. History of a lumbar fusion was associated with lower odds of neuraxial anesthesia use in THA (OR: 0.74 CI: 0.70–0.79, p ≤0.0001) and TKA (OR: 0.80 CI: 0.77–0.84, p ≤0.0001). Previous lumbar fusion -but not decompression- surgery is associated with lower neuraxial anesthesia in THA/TKA patients, despite its use being universally associated with decreased length of stay. More research is needed to address the importance of neuraxial techniques in patients with prior spine surgery. • Lumbar procedures are common in the U.S. and are expected to increase in practice. • We analyzed more than 2.1 million patients undergoing total joint arthroplasty. • Only 15.6% of patients with previous lumbar fusion received neuraxial anesthesia. • History of a lumbar fusion was associated with lower odds of neuraxial anesthesia use. [ABSTRACT FROM AUTHOR]

• Significant racial difference exists in the provision of regional anesthesia and analgesia. • Hospitals with a low volume of joint arthroplasties tended to serve a relative larger proportion of minority patients. • Our data suggest a potential role of hospital-specific factors as targets to reduce these disparities. [ABSTRACT FROM AUTHOR]