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Difference in short-term comlication between sipnal and general anesthesia for Primary TKA

Difference in short-term comlication between sipnal and general anesthesia for Primary TKA. Andrew J pugely MD University of Iowa Hospital. Background. Spinal anesthesia lower incidence of DVT shorter oprative time less blood loss General anesthesia

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Difference in short-term comlication between sipnal and general anesthesia for Primary TKA

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  1. Difference in short-term comlication between sipnal and general anesthesia for Primary TKA Andrew J pugely MD University of Iowa Hospital

  2. Background • Spinal anesthesia lower incidence of DVT shorter oprative time less blood loss • General anesthesia worse performance in morbidity and mortality

  3. Purpose • Identify difference between two mothods • Compare the mobidity and mortality in 30d

  4. Methods • Database From ACS NSQIP Between 2005 and 2010 SA 6030 GA 8022 • Objective Patient characteristics 30D compication rates mortality • Statistics Multivariate logistic regression

  5. Results • 14052 cases 42.9% under spinal anesthesia(SA) 57.1% under general anesthesia(GA) • SA(unadjusted) - lower frequency superficial wound infection the length of surgery the length of hospital stay • GA(adjusted confouders) Higher likelihood of complications

  6. Results • Preoperative comorbidities • Age/female/black race/elevated creatinine/ ASAC/operative time /anesthesia choice/ are independent risk factors

  7. Conclusion • patients managed with GA had a small but significant increase in the risk of complications • patients especially with multiple comorbidities may consider spinal anesthesia

  8. TIPS 1 • Spinal anesthesia increased potential for paresthesias neurologic injury • a few articles demostated no significant difference between SA and GA • limited by small patient numbers no multicenter prospective comparison

  9. TIPS 2 • ACS NSQIP National surgical quality improvement program this database was widely used to investigate short-term outcomes ecch participanting institution collect morbidity and mortality data on each patient data collection continue on outpatients the overall disagreement < 1.8% NSQIP has strict definitions for each complication user guide

  10. TIPS 3 • Complication following TKA surgical site infection/wound dehiscence/pe/ dvt/respiration/renal failure/myocardial infarcion/stoke/coma/never injury/urinary infection/sepsis/return within 30D/ • more frequency urinary tract infection/reoperation/blood transfusion

  11. TIPS 4 • Patients characteristic Divided to 4 parts Demographic characteristic(age sex race) Preoperative comorbidity(chronic diseases) Preoperative lab values Operative variable (ASA class/blood tranfusion ,time of surgery )

  12. Discussion • the difference between two mothods <1% • the importance is likely low • greatest difference in patients with highest number of comorbidities

  13. Discussion • database is not orthopaedic specific 7% • 30D short-term • spinal anethesis more prevalent at good hospital • prospective study,no randomized

  14. Discussion • large number(258 hospitals in usa) • Database-based analyses

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