Difference in short-term comlication between sipnal and general anesthesia fo

r Primary TKA

Andrew J pugely MD

University of Iowa Hospital

Background

Spinal anesthesia

lower incidence of DVT

shorter oprative time

less blood loss General anesthesia

worse performance in morbidity and mortality

Purpose

Identify difference between two mothods

Compare the mobidity and mortality in 30d

Methods

Database From ACS NSQIP Between 2005 and 2010 SA 6030 GA 8022 Objective Patient characteristics

30D compication rates mortality Statistics Multivariate logistic regression

Results

14052 cases

42.9% under spinal anesthesia(SA)

57.1% under general anesthesia(GA) SA(unadjusted) - lower frequency

superficial wound infection

the length of surgery

the length of hospital stay GA(adjusted confouders)

Higher likelihood of complications

Preoperative comorbidities

Age/female/black race/elevated creatinine/ ASAC/operative time /anesthesia choice/

are independent risk factors

Results

Conclusion

patients managed with GA had a small but

significant increase in the risk of complications

patients especially with multiple comorbidities may consider spinal anesthesia

TIPS 1

Spinal anesthesia increased potential for paresthesias neurologic injury a few articles demostated no significant differen

ce between SA and GA

limited by small patient numbers no multicenter prospective comparison

ACS NSQIP

National surgical quality improvement program

this database was widely used to investigate short-term outcomes

ecch participanting institution collect morbidity and mortality data on each patient

data collection continue on outpatients

the overall disagreement < 1.8%

NSQIP has strict definitions for each complication

user guide

TIPS 2

Complication following TKA surgical site infection/wound dehiscence/pe/ dvt/r

espiration/renal failure/myocardial infarcion/stoke/coma/never injury/urinary infection/sepsis/return within 30D/

more frequency urinary tract infection/reoperation/blood transfusio

n

TIPS 3

Patients characteristic

Divided to 4 parts

Demographic characteristic(age sex race)

Preoperative comorbidity(chronic diseases)

Preoperative lab values

Operative variable (ASA class/blood

tranfusion ,time of surgery )

TIPS 4

Discussion

the difference between two mothods <1% the importance is likely low greatest difference in patients with highest nu

mber of comorbidities

Discussion

database is not orthopaedic specific 7% 30D short-term spinal anethesis more prevalent at good hospital prospective study,no randomized

Discussion

large number(258 hospitals in usa) Database-based analyses