Better orthopedic surgery outcomes linked to epidural anesthesia

The use of neuraxial, or epidural, anesthesia improved outcomes – including mortality – in patients undergoing hip and knee replacement surgery, according to a new study.

The study, which appears in the May issue of the journal Anesthesiology, was led by Stavros Memtsoudis, MD, PhD, director of Critical Care Services at the Hospital for Special Surgery in New York, N.Y.

Researchers at the Hospital for Special Surgery found that 30-day mortality was significantly higher – 0.18% – in patients who received general anesthesia versus those who received neuraxial anesthesia (0.10%) or a combination of neuraxial and general anesthesia (0.10%).

In addition, patients who receive general anesthesia had higher rates of pulmonary compromise, infections, and acute renal failure, compared to patients who received neuraxial anesthesia or a combination of neuraxial and general anesthesia. ”The influence that the type of anesthetic can have on perioperative outcomes has been vastly underestimated,” Memtsoudis said. “The choice of anesthesia seemed to basically affect every organ system.”

Neuraxial anesthesia was also associated with shorter hospital stays and lower healthcare costs. More than one-third (35.4%) of patients who received general anesthesia had a prolonged hospital stay, compared to 29.7% of those who received neuraxial anesthesia, and 27.4% of patients who received a combination of general and neuraxial.

To increase the use of neuraxial anesthesia, Memtsoudis said education of patients is key. “Some patients don’t like the idea of having an injection in their back and their legs being numb, but a thorough discussion of risks, benefits, and alternatives can go a long way to help an educated patient make rational decisions,” he said.