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Neuraxial anesthesia improves long-term survival after total joint replacement: a retrospective nationwide population-based study in Taiwan.

Authors :
Chen WH
Hung KC
Tan PH
Shi HY
Source :
Canadian journal of anaesthesia = Journal canadien d'anesthesie [Can J Anaesth] 2015 Apr; Vol. 62 (4), pp. 369-76. Date of Electronic Publication: 2015 Jan 22.
Publication Year :
2015

Abstract

Introduction: This study explored the effects of general (GA) and neuraxial (NA) anesthesia on the outcomes of primary total joint replacement (TJR) in terms of postoperative mortality, length of stay (LOS), and hospital treatment costs.<br />Methods: From 1997 to 2010, this nationwide population-based study retrospectively evaluated 7,977 patients in Taiwan who underwent primary total hip or knee replacement. We generated two propensity-score-matched subgroups, each containing an equal number of patients who underwent TJR with either GA or NA.<br />Results: Of the 7,977 patients, 2,990 (37.5%) underwent GA and 4,987 (62.5%) underwent NA. Propensity-score matching was used to create comparable GA and NA groups adjusted for age, sex, comorbidities, surgery type, hospital volume, and surgeon volume. Survival over the first three years following surgery was similar. The proportion of patients alive up to 14 years postoperatively for those undergoing NA was 58.2% (95% confidence interval [CI] 50.4 to 66.0), and for those undergoing GA it was 57.3% (95% CI 51.4 to 63.2). Neuraxial anesthesia was associated with lower median [interquartile range; IQR] hospital treatment cost ($4,079 [3,805-4,444] vs $4,113 [3,812-4,568]; P < 0.001) and shorter median [IQR] LOS (8 [7-10] days vs 8 [6-10] days, respectively; P = 0.024).<br />Conclusions: Our results support the use of NA for primary TJR. The improvements in hospital costs persist even when anesthesia costs are removed. The mechanism underlying the association between NA and long-term survival is unknown.

Details

Language :
English
ISSN :
1496-8975
Volume :
62
Issue :
4
Database :
MEDLINE
Journal :
Canadian journal of anaesthesia = Journal canadien d'anesthesie
Publication Type :
Academic Journal
Accession number :
25608641
Full Text :
https://doi.org/10.1007/s12630-015-0316-0