"The analysis of 94 studies revealed that neuraxial anesthesia was associated with lower odds or no difference in virtually all reported complications, except for urinary retention. (Pulmonary, acute renal failure, DVT, infections, and blood transfusions)

Recommendation: primary neuraxial anesthesia is preferred for knee arthroplasty given several positive postoperative outcome benefits; evidence level low, weak recommendation.

Recommendation: neuraxial anesthesia is recommended for hip arthroplasty given associated outcome benefits; evidence level:moderate-low, strong recommendation.

Based on current evidence, the consensus group recommends neuraxial over general anesthesia for hip/knee arthroplasty."

"Multivariate analysis demonstrated that patients administered general anesthesia had significantly longer procedure time (174.8 vs 161.3, P < 0.01), and higher intraoperative blood loss total (402.6 vs 305.5 mL, P < 0.01), and total perioperative blood loss (1,802.2 vs 1,684.2, P < 0.01). In addition, patients administered general anesthesia were found to have higher odds for two or more inhospital complications (odds ratio, 2.45, P = 0.02)

Our study shows that propensity-matched patients who received spinal anesthesia for revision THA exhibited notable reduction in surgical time, perioperative blood loss, and complications compared with patients who received general anesthesia, suggesting that spinal anesthesia is a viable alternative to general anesthesia in revision THA"

"Results: Patients undergoing revision TKA with general anesthesia had increased risk of several postoperative complications, even after controlling for baseline patient characteristics. Specifically, there were significantly increased rates of the following: unplanned readmission (OR ¼ 1.43, 95% confidence interval [CI] ¼ 1.18-1.72, P < .001), nonhome discharge (OR ¼ 1.60, 95% CI ¼ 1.46-1.76, P < .001), transfusion (OR ¼ 1.63, 95% CI ¼ 1.41-1.88, P < .001), deep surgical site infection (OR ¼ 1.43, 95% CI ¼ 1.01-2.03, P ¼ .043), and extended length of stay (OR ¼ 1.22, 95% CI ¼ 1.11-1.34, P < .001). General anesthesia was additionally associated with increased operative time.

Conclusion: General anesthesia is associated with increased risk of numerous postoperative complications in patients undergoing revision TKA. This study is retrospective in nature, and while causality cannot be definitively determined, the results suggest that spinal anesthesia is preferential to general anesthesia in the revision TKA patient"

"This 2-year, prospective, observational study was conducted at a single institution where patients receiving primary TJA were consecutively enrolled. Patients were contacted postoperatively to assess for any 90-day complications. The primary outcome of the study was the overall complication rate. Results: A total of 2242 patients underwent total hip arthroplasty (n = 656; 29.26%) or total knee arthroplasty (n = 1586; 70.74%) between 2015 and 2017. Of these procedures, 1325 (59.10%) were carried out under SA and 917 (40.90%) were carried out under GA. Patients in the GA cohort had higher mean Charlson Comorbidity Index scores (0.05 SA vs 0.09 GA; P < .05) and higher average body mass index (29.35 SA vs 30.24 GA; P < .05). On multivariate analysis, patients in the SA cohort had a significantly lower overall complication rate relative to their GA counterparts (7.02% vs 10.14%; odds ratio, 0.66; 95% confidence interval, 0.49-0.90; P < .05). In addition, length of stay in the GA cohort was significantly longer (2.43 [SD, 1.62] vs 2.18 [SD, 0.88] days; P < .01) and a larger percentage of GA patients were discharged to a nursing facility (32.28% vs 25.06%; odds ratio, 0.55; 95% confidence interval, 0.44-0.70; P < .05). Conclusion: Our study demonstrates that SA for TJA is associated with a decrease in overall complications and healthcare resource utilization"