Does spinal anesthesia for total hip or knee arthroplasty entail longer operating room occupancy compared to general anesthesia? Case-control study of 337 spinal versus 243 general anesthesias.

BACKGROUND

Treatment protocols, including anesthesia, are constantly progressing to improve rapid early postoperative recovery in lower-limb arthroplasty. To the best of our knowledge, however, no studies compared general versus spinal anesthesia (GA vs. SA) in the surgical pathway of patients undergoing total knee or hip arthroplasty (TKA, THA). Better knowledge of the processes should improve efficacy in theater and optimize surgical planning. The present study comparing GA and SA in the operating room aimed to assess 1) theater occupancy times, and 2) times for each step in a surgery day according to type of anesthesia.

HYPOTHESIS

SA leads to longer theater occupancy than GA in TKA and THA.

METHODS

A single-center retrospective case-control study analyzed data for the period January 2019 to December 2020 in 303 TKAs (100 GA, 203 SA) and 277 THAs (143 GA, 134 SA), comparing times for all perioperative steps and particularly theater occupancy.

RESULTS

In TKA, occupancy did not differ between GA and SA: 98 ± 16 min versus 98 ± 14 min respectively; Δ = 0 min (p = 0.78). In THA, occupancy was shorter with SA than GA: 117 ± 23 min versus 123 ± 26 min respectively; Δ = - 6 min (p = 0.02). In THA, time to perform SA was longer than induction of GA: 28 ± 13 min versus 23 ± 12 min respectively; Δ = + 5 min (p<0.001). In TKA, time to leaving the operating room was shorter with SA than GA: 8 ± 5 min versus 14 ± 7 min respectively; Δ = - 6 min (p<0.001). Discussion / Conclusion: SA did not involve longer mean theater occupancy than GA for TKA, and reduced it by 6 minutes for THA.

LEVEL OF EVIDENCE

III; case-control study.

Informations de copyright

Copyright © 2023. Published by Elsevier Masson SAS.