Comparative perioperative outcomes associated with anesthetic technique for total hip arthroplasty: a retrospective cohort study

Abstract Background The influence of anesthetic technique on perioperative outcomes for total hip arthroplasty remains poorly elucidated. We studied a sample of total hip arthroplasty recipients, hypothesizing that spinal anesthesia has a superior impact on perioperative outcomes. Methods We conducted a retrospective cohort study of patients undergoing total hip arthroplasty between December 1, 2012 and October 31, 2018 in Zhongnan Hospital of Wuhan University. The primary outcome was cardiorespiratory complications. Secondary outcomes were intraoperative hypotension, packed red blood cells (pRBCs) transfusion, prolonged hospital length of stay, intensive care unit (ICU) use, life-threatening event, and mortality. Multivariable regression analyses were used to identify the impact of anesthetic technique on perioperative outcomes. Results Among the 1,233 patients, 561 had general anesthesia, and 672 had spinal anesthesia. Patients were averagely younger in general group than in spinal anesthesia group, (69.0 and 72.1 years, respectively; P < 0.001), with insignificant difference in comorbidity burden. When spinal anesthesia was used, the hospital length of stay, ICU times, and volume of pRBCs transfusion were significant decreased (P < 0.05). Life-threatening event and in-hospital mortality occurred frequently in general anesthesia, but with insignificant difference. After adjusting for covariates, spinal anesthesia was associated with 54.3% reduction in cardiorespiratory complications (adjusted odds ratio [OR]: 0.457, 95% confidence interval [CI]: 0.320–0.652; P < 0.001). Spinal anesthesia was favorably associated with decreased odds for intraoperative hypotension (OR: 0.653, 95% CI: 0.494–0.863; P = 0.003) and ICU use (OR: 0.371, 95% CI: 0.268–0.514; P < 0.001). The use of spinal anesthesia was not found to influence the risk of pRBCs transfusion (adjusted odds ratio [OR]: 0.823, 95% CI: 0.631–1.073; P = 0.149) and prolonged hospital length of stay (adjusted odds ratio [OR]: 0.886, 95% CI: 0.684–1.148; P = 0.360). Conclusions Compared with general anesthesia, spinal anesthesia for total hip arthroplasty was associated with decreased rates of cardiorespiratory complications, intraoperative hypotension, and ICU use.