Association Between Anesthesia Modality and Registry-Recorded Adverse Events in Knee Arthroscopy: A National Database Study

This is the authors' abstract. We don't add key points for this paper.

Background/Objectives: This study evaluated associations between anesthesia modality and adverse events after elective knee arthroscopy. Methods: This retrospective cohort study evaluated adults undergoing elective knee arthroscopy in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) from 2011–2023. Principal anesthesia was classified as general, monitored anesthesia care (MAC), regional, or neuraxial. We used generalized overlap weighting to balance baseline characteristics within procedure-year groups containing all four anesthesia categories. The primary outcome combined registry-recorded perioperative and 30-day adverse events. We compared each non-general category with general anesthesia using bootstrap confidence intervals and Holm-adjusted tests. Results: Of 168,626 complete cases, 138,680 entered the primary analysis, with 1883 adverse events. Weighted risks were 1.41% for general, 1.55% for MAC, 1.27% for regional, and 1.43% for neuraxial anesthesia. Risk differences versus general, in percentage points, were MAC 0.14 (95% CI, −0.33 to 0.61), regional −0.14 (−0.91 to 0.62), and neuraxial 0.02 (−0.51 to 0.54). All three Holm-adjusted p-values were 1.00. Regional anesthesia contributed only 11 events. A full-cohort Firth analysis included 2450 events, and all anesthesia odds-ratio intervals included one. Conclusions: No statistically significant association was detected, but the confidence intervals do not establish equivalent risks. Findings apply to the population represented in the weighted analysis. Principal codes do not establish exclusive techniques or airway management. Residual confounding, missing-data selection, and unavailable recovery outcomes limit interpretation.