{
  "abstract": "Introduction Over a decade ago, our study group showed improved outcomes among total hip/knee arthroplasty (THA/TKA) patients given neuraxial versus general anesthesia. As the use of neuraxial anesthesia has increased and anesthesia practices evolve, updated analyses are critical to ensure if previously found differences still persist.Methods This retrospective cohort study included elective THA/TKAs from 2006 to 2021 as recorded in the all-payor Premier Healthcare Database. Multivariable regression models measured the association between anesthesia type (neuraxial, general, combined) and several adverse outcomes (pulmonary embolism, cerebrovascular events, pulmonary compromise, cardiac complications, acute myocardial infarction, pneumonia, all infections, acute renal failure, gastrointestinal complications, postoperative mechanical ventilation, intensive care unit admissions, and blood transfusions); models were run separately by period (2006–2015 and 2016–2021) and THA/TKA.Results We identified 587,919 and 499,484 THAs for 2006–2015 and 2016–2021, respectively; this was 1,186,483 and 803,324 for TKAs. Among THAs, neuraxial anesthesia use increased from 10.7% in 2006 to 25.7% in 2021; during both time periods, specifically neuraxial versus general anesthesia was associated with lower odds for most adverse outcomes, with sometimes stronger (protective) effect estimates observed for 2016–2021 versus 2006–2015 (eg, acute renal failure OR 0.72 CI 0.65 to 0.80 vs OR 0.56 CI 0.50 to 0.63 and blood transfusion OR 0.91 CI 0.89 to 0.94 vs OR 0.44 CI 0.41 to 0.47, respectively; all p<0.001). Similar patterns existed for TKAs.Conclusion These findings re-confirm our study group’s decade-old study using more recent data and offer additional evidence toward the sustained benefit of neuraxial anesthesia in major orthopedic surgery.",
  "authors": [
    {
      "affiliations": [
        "Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA"
      ],
      "name": "Alex Illescas"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria"
      ],
      "name": "Crispiana Cozowicz"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA"
      ],
      "name": "Haoyan Zhong"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA",
        "Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria"
      ],
      "name": "Lisa Reisinger"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA"
      ],
      "name": "Jiabin Liu"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA",
        "Departments of Orthopaedics / Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA"
      ],
      "name": "Jashvant Poeran"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA",
        "Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical Private University, Salzburg, Austria",
        "Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA"
      ],
      "name": "Stavros G Memtsoudis"
    }
  ],
  "title": "Comparative effectiveness of neuraxial versus general anesthesia in total joint replacement surgery: an updated retrospective analysis using more recent data",
  "uid": "9860e8cd-cff1-577b-91c1-8948815b40ad"
}