Article Figures & Tables
Figures
- Fig. 1
Estimates of survival probability within 90 days after (A) total hip arthroplasty or (B) total knee arthroplasty, grouped by anesthesia type (general or spinal). The shading represents the 95% confidence interval.
Tables
- Table 1
Characteristics of the matched cohort of patients who underwent total hip arthroplasty*
Characteristic No. (%) of patients† p value‡ Spinal anesthesia
n = 3050General anesthesia
n = 3050Sex > 0.99 Male 1314 (43.1) 1313 (43) Female 1736 (56.9) 1737 (57) Age, yr, mean ± SD 63.7 ± 11.9 63.6 ± 12.2 0.75 BMI, mean ± SD 29.8 ± 5.9 29.8 ± 6.1 0.97 ASA score > 0.99 1 or 2 2235 (73.3) 2236 (73.3) 3 or 4 815 (26.7) 814 (26.7) Medical comorbidities§ Cancer 436 (14.3) 446 (14.6) 0.74 Cardiac illness 659 (21.6) 665 (21.8) 0.88 Chronic hepatic conditions 50 (1.6) 51 (1.7) > 0.99 Chronic pulmonary conditions 319 (10.5) 324 (10.6) 0.87 Chronic renal conditions 91 (3) 99 (3.2) 0.61 Dementia 26 (0.9) 26 (0.9) > 0.99 Diabetes with complications 364 (11.9) 366 (12.0) 0.97 Previous stroke 33 (1.1) 34 (1.1) > 0.99 Obesity 442 (14.5) 456 (15) 0.64 Moderate or severe mental health disorders 138 (4.5) 138 (4.5) > 0.99 ASA = American Society of Anesthesiologists, BMI = body mass index, SD = standard deviation.
↵* 14 677 records of patients with spinal anesthesia were extracted and were matched with 3050 records of patients with general anesthesia on age, sex, BMI, ASA Score and baseline comorbidities using the propensity score matching technique.
↵† Unless indicated otherwise.
↵‡ Propensity scores were used to control for selection bias between the spinal and general anesthesia groups, and propensity-adjusted p values (from χ2 test for categorical variables and Student t test for continuous variables) for preoperative patient characteristics are reported. The model successfully reduced selection bias by eliminating significant differences in preoperative variables (the adjusted p value was > 0.05 for all).
↵§ Chronic pulmonary conditions include congenital disorder of the respiratory system, chronic obstructive pulmonary disease, pulmonary hypertension, respiratory failure, cystic fibrosis, tuberculosis and other chronic lung disease. Moderate or severe mental health disorders include delusional disorder (including schizophrenia), bipolar or manic mood disorder, eating disorder, intellectual disorder or delay, and mental disorder resulting from brain injury or other illness.
- Table 2
Characteristics of the matched cohort of patients who underwent total knee arthroplasty*
Characteristic No. (%) of patients† p value‡ Spinal anesthesia
n = 2790General anesthesia
n = 2790Sex > 0.99 Male 1009 (36.2) 1009 (36.2) Female 1781 (63.8) 1,781 (63.8) Age, yr, mean ± SD 66.2 ± 9.3 66.2 ± 9.5 0.84 BMI, mean ± SD 33.4 ± 6.4 33.3 ± 6.6 0.78 ASA score 0.98 1 or 2 1845 (66.1) 1847 (66.2) 3 or 4 945 (33.9) 943 (33.8) Medical comorbidities§ Cancer 361 (12.9) 362 (13) > 0.99 Cardiac illness 771 (27.6) 779 (27.9) 0.83 Chronic hepatic conditions 47 (1.7) 47 (1.7) > 0.99 Chronic pulmonary conditions 284 (10.2) 291 (10.4) 0.79 Chronic renal conditions 89 (3.2) 91 (3.3) 0.94 Dementia 30 (1.1) 32 (1.1) 0.90 Diabetes with complications 595 (21.3) 605 (21.7) > 0.99 Previous stroke 48 (1.7) 48 (1.7) > 0.99 Obesity 783 (28.1) 783 (28.1) > 0.99 Moderate or severe mental health disorders 131 (4.7) 131 (4.7) > 0.99 ASA = American Society of Anesthesiologists, BMI = body mass index, SD = standard deviation.
↵* 22 357 records of patients with spinal anesthesia were extracted and matched with 2790 records of patients with general anesthesia on age, sex, BMI, ASA Score and baseline comorbidities using the propensity score matching technique.
↵† Unless indicated otherwise.
↵‡ Propensity scores were used to control for selection bias between the spinal and general anesthesia groups, and propensity-adjusted p values (from χ2 test for categorical variables and by Student t test for continuous variables) for preoperative patient characteristics are reported. The model successfully reduced selection bias by eliminating significant differences in preoperative variables (the adjusted p value was > 0.05 for all).
↵§ Chronic pulmonary conditions include congenital disorder of the respiratory system, chronic obstructive pulmonary disease, pulmonary hypertension, respiratory failure, cystic fibrosis, tuberculosis and other chronic lung disease.
Moderate or severe mental health disorders include delusional disorder (including schizophrenia), bipolar or manic mood disorder, eating disorder, intellectual disorder or delay, and mental disorder resulting from brain injury or other illness.
- Table 3
Adjusted primary outcomes of matched cohort of patients who underwent total joint arthroplasty*
Outcome Total hip arthroplasty Total knee arthroplasty No. (%) of patients with spinal anesthesia
n = 3050No. (%) of patients with general anesthesia
n = 3050OR spinal v. general anesthesia (95% CI) No. (%) of patients with spinal anesthesia
n = 2790No. (%) of patients with general anesthesia
n = 2790OR spinal v. general anesthesia (95% CI) Inpatient mortality 0 (0.0) 0 (0.0) 0.95 (0.00 to 110.59) 0 (0.0) 1 (0.0) 0.68 (0.02 to 3.63) 30-day mortality 2 (0.1) 0 (0.0) 1.45 (0.95 to 2.44) 2 (0.1) 4 (0.1) 0.92 (0.90 to 0.95) 60-day mortality 4 (0.1) 1 (0.0) 1.30 (1.12 to 1.52) 3 (0.1) 5 (0.2) 0.92 (0.90 to 0.95) 90-day mortality 5 (0.2) 3 (0.1) 1.08 (1.05 to 1.12) 3 (0.1) 7 (0.2) 0.85 (0.83 to 0.87) CI = confidence interval, OR = odds ratio.
↵* Adjusted for age, sex, body mass index, American Society of Anesthesiologists score and baseline comorbidities (including diabetes, cardiac illness, pulmonary condition, cancer, stroke, renal dysfunction, hepatic dysfunction, obesity, dementia and mental illness) using multiple logistic regression.
- Table 4
Adjusted secondary outcomes of matched cohort of patients who underwent total joint arthroplasty*
Measure Total hip arthroplasty Total knee arthroplasty No. (%) of patients with spinal anesthesia
n = 3050No. (%) of patients with general anesthesia
n = 3050OR spinal v. general anesthesia (95% CI) No. (%) of patients with spinal anesthesia
n = 2790No. (%) of patients with general anesthesia
n = 2790OR spinal v. general anesthesia (95% CI) Blood transfusion 168 (5.5) 220 (7.2) 0.75 (0.60 to 0.92) 102 (3.7) 189 (6.8) 0.52 (0.40 to 0.67) Discharge home 2794 (91.6) 2777 (91.0) 1.07 (0.88 to 1.30) 2626 (94.1) 2543 (91.2) 1.61 (1.30 to 2.00) 30-day readmission 50 (1.6) 58 (1.9) 0.87 (0.59 to 1.28) 64 (2.3) 63 (2.3) 1.03 (0.72 to 1.47) 60-day readmission 74 (2.4) 84 (2.8) 0.89 (0.64 to 1.22) 94 (3.4) 99 (3.6) 0.96 (0.72 to 1.28) 90-day readmission 97 (3.2) 120 (3.9) 0.81 (0.61 to 1.06) 130 (4.7) 137 (4.9) 0.95 (0.74 to 1.23) Deep infection 13 (0.4) 10 (0.3) 1.05 (0.99 to 1.13) 9 (0.3) 9 (0.3) 1.00 (0.92 to 1.09) CI = confidence interval, OR = odds ratio.
↵* Adjusted for age, sex, body mass index, American Society of Anesthesiologists score and baseline comorbidities (including diabetes, cardiac illness, pulmonary condition, cancer, stroke, renal dysfunction, hepatic dysfunction, obesity, dementia and mental illness).
- Table 5
Adjusted mean length of acute hospital stay of matched cohort of patients who underwent total joint arthroplasty*
Cohort Length of stay, d, mean ± SD Mean difference (95% CI) Spinal anesthesia General anesthesia Total hip arthroplasty 3.33 ± 2.13 3.05 ± 2.35 0.28 (0.17 to 0.39) Total knee arthroplasty 3.43 ± 2.08 3.78 ± 4.07 −0.34 (−0.51 to −0.18) CI = confidence interval, SD = standard deviation.
↵* Adjusted for age, gender, body mass index, American Society of Anesthesiologists score and comorbidities (including diabetes, cardiac illness, pulmonary condition, cancer, stroke, renal dysfunction, hepatic dysfunction, obesity, dementia and mental illness) using multiple linear regression.
- Table 6
Postoperative complications of matched cohort of patients who underwent total joint arthroplasty
Characteristic Total hip arthroplasty Total knee arthroplasty No. (%) of patients with spinal anesthesia
n = 3050No. (%) of patients with general anesthesia
n = 3050OR spinal v. general anesthesia (95% CI) No. (%) of patients with spinal anesthesia
n = 2790No. (%) of patients with general anesthesia
n = 2790OR spinal v. general anesthesia (95% CI) Myocardial infarction 5 (0.16) 3 (0.1) 1.08 (1.07 to 1.08) 1 (0.04) 7 (0.25) 0.55 (0.27 to 0.96) Pneumonia 0 (0) 1 (0.03) 0.65 (0.02 to 3.44) 4 (0.14) 7 (0.25) 0.84 (0.74 to 0.93) Gastrointestinal bleed 3 (0.10) 1 (0.03) 1.59 (0.53 to 8.68) 1 (0.04) 2 (0.07) 0.82 (0.04 to 8.03) Ileus 12 (0.39) 6 (0.2) 1.29 (1.25 to 1.34) 9 (0.32) 8 (0.29) 1.07 (0.93 to 1.23) Bleeding* 16 (0.52) 24 (0.79) 0.89 (0.86 to 0.91) 20 (0.72) 22 (0.79) 0.96 (0.90 to 1.02) Delirium 11 (0.36) 14 (0.46) 0.98 (0.97 to 0.98) 14 (0.50) 8 (0.29) 1.10 (1.07 to 1.13) Acute kidney injury 3 (0.10) 2 (0.07) 1.07 (1.03 to 1.12) 2 (0.07) 6 (0.22) 0.86 (0.85 to 0.87) CI = confidence interval, OR = odds ratio.
↵* Bleeding, defined as any of the following codes from the International Classification of Diseases, 10th edition: D500 — anemia due to blood loss; D62 — acute anemia; D683 — hemorrhagic disorders due to anticoagulants; D69 — other hemorrhagic conditions; G361 — hemorrhagic leukoencephalitis; H113 — conjunctival hemorrhage; H356 — retinal hemorrhage; H431 — vitreous hemorrhage; H450 — vitreous hemorrhage; I60 — hemorrhage; I61 — hemorrhage; I62 — hemorrhage; J942 — hemothorax; J9500 — hemorrhage from tracheostomy stoma; K5520 —angiodysplasia; K625 — hemorrhage of anus and rectum; K661 — hemoperitoneum; M250 — haemarthrosis; R04 — hemorrhage from respiratory passages; R31 — hematuria; R58 — hemorrhage, NEC; R823 — hemoglubinuria; S064 — epidural hemorrhage;T810 — hemorrhage and hematoma, NEC.
In this issue
Article tools
Related Articles
Cited By...
- No citing articles found.