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

BACKGROUND

The predominant anesthetic options for total hip arthroplasty (THA) include general anesthesia (GA) and neuraxial anesthesia (NA). The decision on which method of anesthesia to utilize remains debated. The primary objective of this study was to compare length of stay (LOS), operative times, and 90-day complication rates in patients undergoing THA with NA versus GA.

METHODS

Data from primary THAs performed between January 2016 and December 2022 at a single institution were collected retrospectively using the Michigan Arthroplasty Registry Collaborative Quality Initiative database. Demographics, medical comorbidities, intra-operative variables, and postoperative complications were recorded. Patients were subdivided into the NA or GA cohorts. Statistical analysis was performed utilizing unpaired t-tests and χ2 tests.

RESULTS

10,677 THAs performed under NA (4891, 45.81 %) and GA (5786, 54.19 %) were utilized. Patients receiving GA were more likely to be younger, male, active smokers, single, and have a higher comorbidity burden. The GA cohort had longer lengths of stay (1.59 ± 1.59 vs 1.51 ± 1.17 days; p < .01) and surgical times (80.94 ± 28.88 vs 65.70 ± 23.49 min; p < .001). Patients receiving NA were more likely to be discharged home with self care (30.71 % vs 18.86 %; p < .001). All-cause 90-day events were higher among GA including readmissions (4.87 % vs 3.88 %; p < .05), return to the operating room (2.73 % vs 1.84 %; p < .01), and death (0.21 % vs 0.04 %; p < .05).

CONCLUSIONS

This large retrospective study demonstrated that THA performed under NA was associated with shorter hospital length of stay, reduced operative times, and lower 90-day complication rates compared to GA. Despite the higher-risk profile of GA patients, which likely contributed to increased complication profile, NA facilitated faster recovery and higher rates of discharge home with self-care.