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Neuraxial anesthesia improves long-term survival after total joint replacement: a retrospective nationwide population-based study in Taiwan.
- 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.
- Subjects :
- Aged
Anesthesia, Conduction economics
Anesthesia, General economics
Arthroplasty, Replacement, Hip economics
Arthroplasty, Replacement, Knee economics
Female
Follow-Up Studies
Hospital Costs
Humans
Length of Stay statistics & numerical data
Male
Middle Aged
Postoperative Complications epidemiology
Postoperative Complications mortality
Propensity Score
Retrospective Studies
Survival Rate
Taiwan
Anesthesia, Conduction methods
Anesthesia, General methods
Arthroplasty, Replacement, Hip methods
Arthroplasty, Replacement, Knee methods
Subjects
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