The Association of Primary Anesthesia Type With Postoperative Transfusion in Anemic Patients Undergoing Primary Total Joint Arthroplasty

Background and objective

A high rate of preoperative anemia has been observed in patients undergoing knee and hip arthroplasty. The type of anesthesia that patients receive may play a role in preventing or minimizing adverse outcomes in these patients. In this study, we aimed to examine the complication rates in patients with severe anemia undergoing this surgery. In addition, we explore whether neuraxial anesthesia is associated with better outcomes compared to general anesthesia.

Methods

The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) registry was used to extract data related to patients who underwent total hip or knee arthroplasty from 2014 to 2016. Only those patients with a hematocrit level <30% were included, and they were classified into two groups based on primary anesthesia type received: neuraxial versus general anesthesia. The primary outcome of interest was postoperative transfusion. Secondary outcomes included 30-day hospital readmission and postoperative complications. Multivariable logistic regression was used to model primary anesthesia type to outcomes while controlling for various confounders. The odds ratio (OR) and their 95% confidence intervals (CI) were reported.

Results

There were 1,723 patients with severe anemia included in our analysis, of which 41.2% received neuraxial anesthesia. Among patients that received neuraxial versus general anesthesia, 170 (31.08%) and 486 (41.33%), respectively, received a postoperative blood transfusion (p<0.001). On multivariable regression analysis, neuraxial anesthesia was associated with 40% decreased odds of postoperative transfusion (OR: 0.63, 95% CI: 0.51-0.79, p<0.0001), but it was not associated with any other outcomes.

Conclusion

Neuraxial anesthesia can reduce the risk of postoperative transfusion in severely anemic patients undergoing total joint arthroplasty (TJA), ultimately leading to reduced discomfort, hospital expenditure, and adverse outcomes.