Does regional anaesthesia reduce complications following total hip and knee replacement compared with general anaesthesia? An analysis from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man

Gulraj S Matharu, Cesar Garriga, Amar Rangan, Andrew Judge

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Abstract

BackgroundRegional anaesthesia is increasingly used in enhanced recovery programmes following total hip replacement (THR) and total knee replacement (TKR). However debate remains about its potential benefit over general anaesthesia given complications following surgery are rare. We assessed the risk of complications in THR and TKR patients receiving regional anaesthesia compared with general anaesthesia using the world’s largest joint replacement registry.
MethodsWe studied the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man linked to English hospital inpatient episodes for 779,491 patients undergoing THR and TKR. Patients received either regional anaesthesia (n=544,620, 70%) or general anaesthesia (n=234,871, 30%). Outcomes assessed at 90 days included length of stay, readmissions, and complications. Regression models were adjusted for patient and surgical factors to determine the effect of anaesthesia on outcomes.
ResultsLength of stay was reduced with regional anaesthesia compared with general anaesthesia (THR=-0.49 days, 95% confidence interval (CI)=-0.51 to -0.47 days, p<0.001; TKR=-0.4725 days, CI=-0.49 to -0.45 days, p<0.001). Regional anaesthesia also had a reduced risk of readmission (THR odds ratio (OR)=0.93, CI=0.90-0.96; TKA OR=0.91, CI=0.89-0.93); any complication (THR OR=0.88, CI=0.85-0.91; TKA OR=0.90, CI=0.87-0.93); urinary tract infection (THR OR=0.85, CI=0.77-0.94; TKR OR=0.87, CI=0.79-0.96); and surgical site infection (THR OR=0.87, CI=0.80-0.95; TKR OR=0.84, CI=0.78-0.89). Anaesthesia type did not affect the risk of revision surgery or mortality.
ConclusionsRegional anaesthesia was associated with reduced length of stay, readmissions, and complications following THR and TKR when compared with general anaesthesia. We recommend regional anaesthesia should be considered the reference-standard for patients undergoing THR and TKR.
Original languageEnglish
Article numberE5
Pages (from-to)1521-1528
Number of pages8
JournalJournal of Arthroplasty
Volume35
Issue number6
DOIs
Publication statusPublished - 8 Feb 2020

Keywords

  • Anaesthesia
  • Hip Replacement
  • Knee Replacement
  • Outcome research
  • Orthopaedic Surgery

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