Why the study?
A comparison of different anesthetic techniques to evaluate short term outcomes had yet to be performed for patients undergoing outpatient knee replacements.
Does spinal anesthesia reduce serious adverse events compared to general anesthesia in patients undergoing outpatient total knee arthroplasty?
Does spinal anesthesia reduce serious adverse events compared to general anesthesia in patients undergoing outpatient total knee arthroplasty?
In outpatient total knee arthroplasty, spinal anesthesia is associated with similar rates of serious adverse events but fewer minor adverse events compared to general anesthesia.
Spinal anesthesia was associated with fewer minor events but similar serious adverse events in outpatient TKA; leaves open confirmation in randomized trials.
BACKGROUND: A comparison of different anesthetic techniques to evaluate short term outcomes has yet to be performed for patients undergoing outpatient knee replacements. The aim of this investigation was to compare short term outcomes of spinal (SA) versus general anesthesia (GA) in patients undergoing outpatient total knee replacements. METHODS: The ACS NSQIP datasets were queried to extract patients who underwent primary, elective, unilateral total knee arthroplasty (TKA) between 2005 and 2018 performed as an outpatient procedure. The primary outcome was a composite score of serious adverse events (SAE). The primary independent variable was the type of anesthesia (e.g., general vs. spinal). RESULTS: A total of 353,970 patients who underwent TKA procedures were identified comprising of 6,339 primary, elective outpatient TKA procedures. Of these, 2,034 patients received GA and 3,540 received SA. A cohort of 1,962 patients who underwent outpatient TKA under GA were propensity matched for covariates with patients who underwent outpatient TKA under SA. SAE rates at 72 h after surgery were not greater in patients receiving GA compared to SA (0.92%, 0.66%, P = 0.369). In contrast, minor adverse events were greater in the GA group compared to SA (2.09%, 0.51%), P < 0.001. The rate of postoperative transfusion was greater in the patients receiving GA. CONCLUSIONS: The type of anesthetic technique, general or spinal anesthesia does not alter short term SAEs, readmissions and failure to rescue in patients undergoing outpatient TKR surgery. Recognizing the benefits of SA tailored to the anesthetic management may maximize the clinical benefits in this patient population.
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Kendall et al. (2021) studied this question.
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