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Comparative Perioperative Outcomes Associated With Neuraxial Versus General Anesthesia for Simultaneous Bilateral Total Knee Arthroplasty

Stundner, Ottokar MD*; Chiu, Ya-Lin MS; Sun, Xuming MS; Mazumdar, Madhu PhD, MA, MS; Fleischut, Peter MD; Poultsides, Lazaros MD§; Gerner, Peter MD; Fritsch, Gerhard MD; Memtsoudis, Stavros G. MD, PhD*

Regional Anesthesia and Pain Medicine: November/December 2012 - Volume 37 - Issue 6 - p 638–644
doi: 10.1097/AAP.0b013e31826e1494
Original Articles

Background and Objectives The influence of the type of anesthesia on perioperative outcomes after bilateral total knee arthroplasty (BTKA) remains unknown. Therefore, we examined a large sample of BTKA recipients, hypothesizing that neuraxial anesthesia would favorably impact on outcomes.

Methods We identified patient entries indicating elective BTKA between 2006 and 2010 in a national database; subgrouped them by type of anesthesia: general (G), neuraxial (N), or combined neuraxial-general (NG); and analyzed differences in demographics and perioperative outcomes.

Results Of 15,687 identified procedures, 6.8% (n = 1066) were performed under N, 80.1% (n = 12,567) under G, and 13.1% (n = 2054) under NG. Comparing N to G and NG, patients in group N were, on average, younger (63.9, 64.6, and 64.8 years; P = 0.030) but did not differ in overall comorbidity burden. Patients in group N required blood product transfusions significantly less frequently (28.5%, 44.7%, 38.0%; P < 0.0001). In-hospital mortality, 30-day mortality, and complication rates tended to be lower in group N, without reaching statistical significance. After adjusting for covariates, N and NG were associated with 16.0% and 6.0% reduction in major complications compared with G, but only the reduced odds for the requirement of blood transfusions associated with N reached statistical significance (N vs G: odds ratio, 0.52 [95% CI, 0.45–0.61], P < 0.0001; NG vs G: odds ratio, 0.77 [95% CI, 0.69–0.86], P < 0.0001).

Conclusions Neuraxial anesthesia for BTKA is associated with significantly lower rates of blood transfusions and, by trend, decreased morbidity. Although by itself the effect may be limited, N might be used within a multimodal approach to reduce complications after BTKA.

From the *Department of Anesthesiology, Hospital for Special Surgery, †Division of Biostatistics and Epidemiology, Department of Public Health, ‡Department of Anesthesiology, NewYork–Presbyterian Hospital, §Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY; and ∥Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.

Accepted for publication August 7, 2012.

Address correspondence to: Stavros G. Memtsoudis, MD, PhD, Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021 (e-mail:

The authors declare no conflict of interest.

This work was supported with funds from The Kellen Clinician-Scientist Career Development Award and the Hospital for Special Surgery, Department of Anesthesiology (S.G.M.). Contribution of M.M., Y.-L.C., and X.S. on this project was supported, in part, by funds from the Clinical Translational Science Center, National Center for Advancing Translational Sciences (NCATS) grant no. UL1-RR024996, and the Center for Education, Research, and Therapeutics, Agency for Healthcare Research and Quality (AHRQ) grant no. U18 HSO16-75.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding sources, NCATS and AHRQ, which are based in Rockville, MD.

This work is attributed to the Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY.

©2012 American Society of Regional Anesthesia and Pain Medicine