Association of Anesthesia Type with Postoperative Outcome and Complications in Patients Undergoing Revision Total Knee Arthroplasty.

Revision total knee arthroplasty (TKA) is an increasingly common procedure and is effective in treating knee osteoarthritis, but it has higher complication rates than primary TKA. Anesthetic choice poses perioperative risk that has been extensively studied in primary TKA, showing favorable results for regional anesthesia compared with general anesthesia. The impact of anesthetic choice in revision TKAs is not well studied. A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent revision TKAs between 2014 and 2017 were divided into three anesthesia cohorts: (1) general anesthesia, (2) regional anesthesia, and (3) combined general-regional anesthesia. Univariate and multivariate analyses were used to analyze patient characteristics and 30-day postoperative outcomes. Bonferroni correction was applied for post hoc analysis. In total, 8,820 patients were identified. Of whom, 3,192 patients underwent general anesthesia, 3,474 patients underwent regional anesthesia, and 2,154 patients underwent combined anesthesia. After multivariate analyses, regional anesthesia was associated with decreased odds for any complication (p = 0.008), perioperative blood transfusion (p < 0.001), and extended length of stay (p < 0.001) compared with general anesthesia. In addition, regional anesthesia was associated with decreased odds for perioperative blood transfusion (p < 0.001) and extended length of stay (p = 0.006) compared with combined anesthesia. However, following multivariate analysis, regional anesthesia was not associated with decreased odds of wound, pulmonary, renal, urinary tract, thromboembolic, and cardiac complications, and was not associated with return to operating room, extended length of stay, minor and major complications, and mortality. Retrospective analysis of a large surgical database suggests that patients receiving general anesthesia have increased likelihood for developing adverse postoperative outcomes relative to patients receiving regional anesthesia. Prospective and controlled trials should be conducted to verify these findings.

Increase in Operative Time Is Associated With Postoperative Complications in Revision Total Knee Arthroplasty.

Given the growing rate of revision total knee arthroplasties (TKAs), it is important to understand the potential risk factors associated with postoperative complications. The aim of this study was to determine the role of operative time in postoperative complications in revision TKA. A retrospective cohort study was performed using data from the American College of Surgeons National Surgical Quality Improvement Program database. Patients who had undergone revision TKA between 2007 and 2016 were identified and analyzed based on operative time. The effect of operative time on postoperative complications was examined using multinomial multivariate analysis. A total of 14,769 revision TKA patients were included. On adjusted multivariate analysis, each additional 15 minutes of operative time increased the likelihood of wound complications (odds ratio, 1.023; P=.020), postoperative blood transfusion (odds ratio, 1.169; P<.001), and extended hospital stay (odds ratio, 1.060; P<.001). An increase of 15 minutes of operative time was associated with several postoperative complications. Although operative time is often an uncontrollable factor, surgeons should consider the effect of prolonged operative time on potential complications in the acute postoperative period. [Orthopedics. 2021;44(1):18-22.].