PDF icon Download PDF
J Knee Surg 2022; 35(04): 345-354
DOI: 10.1055/s-0040-1713776
Original Article

Association of Anesthesia Type with Postoperative Outcome and Complications in Patients Undergoing Revision Total Knee Arthroplasty

Chapman Wei  ‡   *
1   Department of Anesthesiology & Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
,
Arun Muthiah‡   *
1   Department of Anesthesiology & Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
,
Alex Gu 
2   Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York
,
Theodore Quan
1   Department of Anesthesiology & Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
,
Kenneth T. Nguyen
3   New York Institute of Technology College of Osteopathic Medicine, Glen Head, New York
,
Safa C. Fassihi
4   Department of Orthopedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
,
Aaron Z. Chen
5   Weill Cornell Medical College, New York City, New York
,
Richard L. Amdur
6   Department of Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
,
Ryan M. Nunley
7   Department of Orthopedic Surgery, Washington University at St Louis School of Medicine, St. Louis, Missouri
,
Jiabin Liu
8   Department of Anesthesiology, Hospital for Special Surgery, New York City, New York
,
Peter K. Sculco
2   Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, New York
,
Jeffrey S. Berger
1   Department of Anesthesiology & Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
› Author Affiliations
Funding None.
› Further Information
   Permissions and Reprints
Preview

Abstract

Revision total knee arthroplasty (TKA) is an increasingly common procedure and is effective in treating knee osteoarthritis, but it has higher complication rates than primary TKA. Anesthetic choice poses perioperative risk that has been extensively studied in primary TKA, showing favorable results for regional anesthesia compared with general anesthesia. The impact of anesthetic choice in revision TKAs is not well studied. A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent revision TKAs between 2014 and 2017 were divided into three anesthesia cohorts: (1) general anesthesia, (2) regional anesthesia, and (3) combined general-regional anesthesia. Univariate and multivariate analyses were used to analyze patient characteristics and 30-day postoperative outcomes. Bonferroni correction was applied for post hoc analysis. In total, 8,820 patients were identified. Of whom, 3,192 patients underwent general anesthesia, 3,474 patients underwent regional anesthesia, and 2,154 patients underwent combined anesthesia. After multivariate analyses, regional anesthesia was associated with decreased odds for any complication (p = 0.008), perioperative blood transfusion (p < 0.001), and extended length of stay (p < 0.001) compared with general anesthesia. In addition, regional anesthesia was associated with decreased odds for perioperative blood transfusion (p < 0.001) and extended length of stay (p = 0.006) compared with combined anesthesia. However, following multivariate analysis, regional anesthesia was not associated with decreased odds of wound, pulmonary, renal, urinary tract, thromboembolic, and cardiac complications, and was not associated with return to operating room, extended length of stay, minor and major complications, and mortality. Retrospective analysis of a large surgical database suggests that patients receiving general anesthesia have increased likelihood for developing adverse postoperative outcomes relative to patients receiving regional anesthesia. Prospective and controlled trials should be conducted to verify these findings.

Keywords

knee replacement arthroplasty - joint revision - regional anesthesia - general anesthesia - combined anesthetics

* The authors contributed equally to the work.




Publication History

Received: 15 October 2019

Accepted: 24 May 2020

Article published online:
14 July 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA