Spinal, General Anesthesia Result in Reliable Same-Day Discharge for Outpatient Total Joint Arthroplasty

According to the results of a retrospective matched cohort comparison study, both spinal and general anesthesia offered reliable same-day discharge (SDD) and similar 90-day complication rates among participants who underwent outpatient total joint arthroplasty (TJA) at a free-standing ambulatory surgical center.

Although spinal anesthesia is most often used in outpatient TJA, induction can be difficult, and the technique may go against patient preference. Therefore, Calkins and colleagues compared the outcomes of SDD TJA with spinal versus general anesthesia at a free-standing ambulatory surgery center.

The researchers identified 105 patients who received general anesthesia before TJA and matched them to 105 patients who received spinal anesthesia for the same procedure during a 7-year span at one ambulatory surgery center. Next, they compared the rate of successful SDD, minutes to discharge, and postoperative pain, nausea, and complications at 90 days. The researchers also examined the different types of spinal anesthesia, analyzing patient outcomes of those who received mepivacaine vs bupivacaine.

The results showed that both anesthetic approaches were reliable for this patient population.

Indeed, all patients who received a spinal anesthesia and underwent TJA had SDD compared with 103 (98%) for the general anesthetic cohort (P = .498). Patients who received mepivacaine spinal anesthesia spent 206 minutes at the postanesthesia care unit before discharge, which was the fastest time among the other options. Patients who received general anesthesia spent 227 minutes at the care unit, followed by those who received bupivacaine spinal anesthesia, who spent 291 minutes there (P < .001).

While the patients who received general anesthesia had higher levels of postoperative pain and rates of nausea compared with spinal anesthesia, 90-day complications and reoperations were similar among the two groups.

“Both spinal and general anesthesia led to reliable SDD with similar 90-day complication rates,” the authors concluded. “General anesthesia facilitated faster discharge from the ambulatory surgical center compared with bupivacaine spinal anesthesia but led to higher levels of pain and incidence of nausea postoperatively.”

Reference
Calkins TE, Johnson EP, Eason RR, Mihalko WM, Ford MC. Spinal versus general anesthesia for outpatient total hip and knee arthroplasty in the ambulatory surgery center: a matched-cohort study. J Arthroplasty. Published online. doi:10.1016/j.arth.2023.12.020