The Effects of General and Regional Anesthesia on Length of Hospital Stay in Patients Undergoing Hip Arthroplasty
Abstract
Introduction and Objective. Hip arthroplasty is a commonly performed orthopedic procedure in older adults, with over 500,000 total hip arthroplasties performed each year in the United States alone. Choices for anesthetic management in these patients include general and regional anesthesia (i.e., spinal, epidural, and peripheral nerve blocks). Existing literature presents mixed findings on the influence of anesthesia type on postoperative length of stay (LOS). This study aims to investigate whether general anesthesia, compared with regional anesthesia, is associated with differences in LOS in patients undergoing hip arthroplasty. Methods. A non-concurrent cohort study was conducted including 33,988 patients in the United States who underwent hip arthroplasty with general or regional anesthesia identified through the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Patients with missing values in the exposure and outcome variables and those in whom other surgeries were concomitantly performed were excluded. The main exposure variable was management with general or regional anesthesia. The primary outcome variable was LOS less than (or equal to) two days vs. three days or more. Several patient demographics and comorbidities were included as covariates. Unadjusted and adjusted logistic regression models were used to calculate odds ratios and 95% confidence intervals. Results. Patients who underwent hip arthroplasty with general anesthesia experienced a proportionally greater number of postoperative complications (GA: 2.3%, RA: 1.2%; p < 0.001). Relative to regional anesthesia, our data suggested that patients who received general anesthesia during total hip arthroplasty had a statistically significant 24% increased odds of having a LOS of three days or more (OR: 1.24, CI: 1.17-1.29). In patients who underwent partial hip arthroplasty, general anesthesia was associated with a statistically significant 342% increased odds as compared to regional anesthesia (OR: 3.42, CI: 2.50-4.66). Conclusions-Implications. Regional anesthesia may be an effective method in reducing LOS in hip arthroplasty patients; an important consideration for preoperative planning by orthopedic surgeons and anesthesiologists. Future research in the form of prospective studies would be beneficial to better characterize this association and understand the effects of anesthesia type on post-operative outcomes including pain management, time to functional recovery, and complications.
Keywords
Hip arthroplasty, General Anesthesia, Regional Anesthesia, Length of Stay
Presentation Type
Oral Presentation
The Effects of General and Regional Anesthesia on Length of Hospital Stay in Patients Undergoing Hip Arthroplasty
Introduction and Objective. Hip arthroplasty is a commonly performed orthopedic procedure in older adults, with over 500,000 total hip arthroplasties performed each year in the United States alone. Choices for anesthetic management in these patients include general and regional anesthesia (i.e., spinal, epidural, and peripheral nerve blocks). Existing literature presents mixed findings on the influence of anesthesia type on postoperative length of stay (LOS). This study aims to investigate whether general anesthesia, compared with regional anesthesia, is associated with differences in LOS in patients undergoing hip arthroplasty. Methods. A non-concurrent cohort study was conducted including 33,988 patients in the United States who underwent hip arthroplasty with general or regional anesthesia identified through the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Patients with missing values in the exposure and outcome variables and those in whom other surgeries were concomitantly performed were excluded. The main exposure variable was management with general or regional anesthesia. The primary outcome variable was LOS less than (or equal to) two days vs. three days or more. Several patient demographics and comorbidities were included as covariates. Unadjusted and adjusted logistic regression models were used to calculate odds ratios and 95% confidence intervals. Results. Patients who underwent hip arthroplasty with general anesthesia experienced a proportionally greater number of postoperative complications (GA: 2.3%, RA: 1.2%; p < 0.001). Relative to regional anesthesia, our data suggested that patients who received general anesthesia during total hip arthroplasty had a statistically significant 24% increased odds of having a LOS of three days or more (OR: 1.24, CI: 1.17-1.29). In patients who underwent partial hip arthroplasty, general anesthesia was associated with a statistically significant 342% increased odds as compared to regional anesthesia (OR: 3.42, CI: 2.50-4.66). Conclusions-Implications. Regional anesthesia may be an effective method in reducing LOS in hip arthroplasty patients; an important consideration for preoperative planning by orthopedic surgeons and anesthesiologists. Future research in the form of prospective studies would be beneficial to better characterize this association and understand the effects of anesthesia type on post-operative outcomes including pain management, time to functional recovery, and complications.