![Page 1: Difference in short-term comlication between sipnal and general anesthesia for Primary TKA Andrew J pugely MD University of Iowa Hospital](https://reader035.vdocuments.mx/reader035/viewer/2022070403/56649f335503460f94c4f2b4/html5/thumbnails/1.jpg)
Difference in short-term comlication between sipnal and general anesthesia fo
r Primary TKA
Andrew J pugely MD
University of Iowa Hospital
![Page 2: Difference in short-term comlication between sipnal and general anesthesia for Primary TKA Andrew J pugely MD University of Iowa Hospital](https://reader035.vdocuments.mx/reader035/viewer/2022070403/56649f335503460f94c4f2b4/html5/thumbnails/2.jpg)
Background
Spinal anesthesia
lower incidence of DVT
shorter oprative time
less blood loss General anesthesia
worse performance in morbidity and mortality
![Page 3: Difference in short-term comlication between sipnal and general anesthesia for Primary TKA Andrew J pugely MD University of Iowa Hospital](https://reader035.vdocuments.mx/reader035/viewer/2022070403/56649f335503460f94c4f2b4/html5/thumbnails/3.jpg)
Purpose
Identify difference between two mothods
Compare the mobidity and mortality in 30d
![Page 4: Difference in short-term comlication between sipnal and general anesthesia for Primary TKA Andrew J pugely MD University of Iowa Hospital](https://reader035.vdocuments.mx/reader035/viewer/2022070403/56649f335503460f94c4f2b4/html5/thumbnails/4.jpg)
Methods
Database From ACS NSQIP Between 2005 and 2010 SA 6030 GA 8022 Objective Patient characteristics
30D compication rates mortality Statistics Multivariate logistic regression
![Page 5: Difference in short-term comlication between sipnal and general anesthesia for Primary TKA Andrew J pugely MD University of Iowa Hospital](https://reader035.vdocuments.mx/reader035/viewer/2022070403/56649f335503460f94c4f2b4/html5/thumbnails/5.jpg)
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
![Page 6: Difference in short-term comlication between sipnal and general anesthesia for Primary TKA Andrew J pugely MD University of Iowa Hospital](https://reader035.vdocuments.mx/reader035/viewer/2022070403/56649f335503460f94c4f2b4/html5/thumbnails/6.jpg)
Preoperative comorbidities
Age/female/black race/elevated creatinine/ ASAC/operative time /anesthesia choice/
are independent risk factors
Results
![Page 7: Difference in short-term comlication between sipnal and general anesthesia for Primary TKA Andrew J pugely MD University of Iowa Hospital](https://reader035.vdocuments.mx/reader035/viewer/2022070403/56649f335503460f94c4f2b4/html5/thumbnails/7.jpg)
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
![Page 8: Difference in short-term comlication between sipnal and general anesthesia for Primary TKA Andrew J pugely MD University of Iowa Hospital](https://reader035.vdocuments.mx/reader035/viewer/2022070403/56649f335503460f94c4f2b4/html5/thumbnails/8.jpg)
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
![Page 9: Difference in short-term comlication between sipnal and general anesthesia for Primary TKA Andrew J pugely MD University of Iowa Hospital](https://reader035.vdocuments.mx/reader035/viewer/2022070403/56649f335503460f94c4f2b4/html5/thumbnails/9.jpg)
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
![Page 10: Difference in short-term comlication between sipnal and general anesthesia for Primary TKA Andrew J pugely MD University of Iowa Hospital](https://reader035.vdocuments.mx/reader035/viewer/2022070403/56649f335503460f94c4f2b4/html5/thumbnails/10.jpg)
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
![Page 11: Difference in short-term comlication between sipnal and general anesthesia for Primary TKA Andrew J pugely MD University of Iowa Hospital](https://reader035.vdocuments.mx/reader035/viewer/2022070403/56649f335503460f94c4f2b4/html5/thumbnails/11.jpg)
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
![Page 12: Difference in short-term comlication between sipnal and general anesthesia for Primary TKA Andrew J pugely MD University of Iowa Hospital](https://reader035.vdocuments.mx/reader035/viewer/2022070403/56649f335503460f94c4f2b4/html5/thumbnails/12.jpg)
Discussion
the difference between two mothods <1% the importance is likely low greatest difference in patients with highest nu
mber of comorbidities
![Page 13: Difference in short-term comlication between sipnal and general anesthesia for Primary TKA Andrew J pugely MD University of Iowa Hospital](https://reader035.vdocuments.mx/reader035/viewer/2022070403/56649f335503460f94c4f2b4/html5/thumbnails/13.jpg)
Discussion
database is not orthopaedic specific 7% 30D short-term spinal anethesis more prevalent at good hospital prospective study,no randomized
![Page 14: Difference in short-term comlication between sipnal and general anesthesia for Primary TKA Andrew J pugely MD University of Iowa Hospital](https://reader035.vdocuments.mx/reader035/viewer/2022070403/56649f335503460f94c4f2b4/html5/thumbnails/14.jpg)
Discussion
large number(258 hospitals in usa) Database-based analyses