Neuraxial versus general anesthesia for primary total knee arthroplasty: A retrospective analysis comparing postoperative outcomes and rates of complications.

Abstract

The predominant anesthetic options for total knee arthroplasty (TKA) include general anesthesia (GA) and neuraxial anesthesia (NA) with or without peripheral nerve blocks. The use of NA continues to expand due to lower 90-day readmission rates and lower complication rates. The primary objective of this study was to compare length of stay (LOS), operative times, and 90-day complication and readmission rates in patients undergoing TKA with NA versus GA. Primary TKAs between January 2016-December 2022 at a single institution were collected retrospectively using the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) database. Demographics, medical comorbidities, intra-operative variables, and postoperative complications were recorded. Patients were then subdivided into the NA or GA cohorts. Statistical analysis was performed utilizing unpaired <i>t</i>-tests and χ² tests. A total of 14,250 primary TKAs, 8645 under SA (61 %) and 5605 under GA (39 %) were performed. Surgical time (88.89 ± 35.15 vs 78.60 ± 24.42 min, p < 0.01), length of stay (2.02 ± 1.67 days vs 1.77 ± 1.34 days, p < 0.01), and all cause 90-day events (22.11 vs 15.64 %; p < 0.01) were significantly higher in GA cohort. This includes readmission rates (6.21 vs 3.62 %, p < 0.01), reoperations (4.53 vs 3.47 %, p = 0.02), and DVT/pulmonary embolism (2.21 vs 1.17 %, p < 0.01). Patients receiving GA were at a higher risk for 90-day readmissions, reoperations, and acute DVT/PE, potentially a result of their higher medical comorbidity burden. Patients in the NA cohort had shorter surgical times and LOS with increased likelihood of being discharged home.