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Anaesthetic care of patients undergoing primary hip and knee arthroplasty: consensus recommendations from the International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) based on a systematic review and meta-analysis.
Memtsoudis, Stavros G; Cozowicz, Crispiana; Bekeris, Janis; Bekere, Dace; Liu, Jiabin; Soffin, Ellen M; Mariano, Edward R; Johnson, Rebecca L; Hargett, Mary J; Lee, Bradley H; Wendel, Pamela; Brouillette, Mark; Go, George; Kim, Sang J; Baaklini, Lila; Wetmore, Douglas; Hong, Genewoo; Goto, Rie; Jivanelli, Bridget; Argyra, Eriphyli; Barrington, Michael J; Borgeat, Alain; De Andres, Jose; Elkassabany, Nabil M; Gautier, Philippe E; Gerner, Peter; Gonzalez Della Valle, Alejandro; Goytizolo, Enrique; Kessler, Paul; Kopp, Sandra L; Lavand'Homme, Patricia; MacLean, Catherine H; Mantilla, Carlos B; MacIsaac, Daniel; McLawhorn, Alexander; Neal, Joseph M; Parks, Michael; Parvizi, Javad; Pichler, Lukas; Poeran, Jashvant; Poultsides, Lazaros A; Sites, Brian D; Stundner, Otto; Sun, Eric C; Viscusi, Eugene R; Votta-Velis, Effrossyni G; Wu, Christopher L; Ya Deau, Jacques T; Sharrock, Nigel E.
Affiliation
  • Memtsoudis SG; Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery and Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA; Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg,
  • Cozowicz C; Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery and Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA; Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg,
  • Bekeris J; Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery and Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA; Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg,
  • Bekere D; Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery and Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA.
  • Liu J; Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery and Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA.
  • Soffin EM; Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery and Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA.
  • Mariano ER; Department of Anesthesia, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
  • Johnson RL; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
  • Hargett MJ; Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery and Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA.
  • Lee BH; Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery and Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA.
  • Wendel P; Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery and Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA.
  • Brouillette M; Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery and Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA.
  • Go G; Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery and Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA.
  • Kim SJ; Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery and Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA.
  • Baaklini L; Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery and Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA.
  • Wetmore D; Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery and Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA.
  • Hong G; Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery and Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA.
  • Goto R; Kim Barrett Memorial Library, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA.
  • Jivanelli B; Kim Barrett Memorial Library, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA.
  • Argyra E; Department of Anaesthesiology, Pain and Palliative Care, National and Kapodistrian University of Athens, Athens, Greece.
  • Barrington MJ; Department of Medicine & Radiology, The University of Melbourne, Victoria, Australia.
  • Borgeat A; Department of Anesthesiology and Intensive Care Medicine, Universität Zürich, Zurich, Switzerland.
  • De Andres J; Anesthesia Unit- Surgical Specialties Department, Valencia University Medical School, Spain; Anesthesia, Critical Care, and Pain Management Department, General University Hospital, Valencia, Spain.
  • Elkassabany NM; Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
  • Gautier PE; Department of Anesthesiology, Clinique Ste-Anne St-Remi, Anderlecht, Belgium.
  • Gerner P; Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.
  • Gonzalez Della Valle A; Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery and Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA.
  • Goytizolo E; Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery and Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA.
  • Kessler P; Department of Anesthesiology, Intensive Care and Pain Medicine, Orthopedic University Hospital, Frankfurt am Main, Germany.
  • Kopp SL; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
  • Lavand'Homme P; Department of Anesthesiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
  • MacLean CH; Value Management Office, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA.
  • Mantilla CB; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
  • MacIsaac D; Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
  • McLawhorn A; Department of Orthopedic Surgery, Hip and Knee Replacement, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA.
  • Neal JM; Department of Anesthesiology, Virginia Mason Medical Center, Seattle, WA, USA.
  • Parks M; Department of Orthopedic Surgery, Hip and Knee Replacement, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA.
  • Parvizi J; Rothman Orthopaedic Institute, Bensalem, PA, USA.
  • Pichler L; Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.
  • Poeran J; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Institute for Healthcare Delivery Science, New York, NY, USA.
  • Poultsides LA; Department of Orthopaedic Surgery, New York Langone Orthopaedic Hospital, New York, NY, USA.
  • Sites BD; Department of Anesthesiology, Dartmouth College Geisel School of Medicine, Hanover, NH, USA.
  • Stundner O; Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.
  • Sun EC; Department of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA.
  • Viscusi ER; Department of Anesthesiology, Pain Center, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
  • Votta-Velis EG; Department of Anesthesiology, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.
  • Wu CL; Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery and Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA.
  • Ya Deau JT; Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery and Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA.
  • Sharrock NE; Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery and Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA.
Br J Anaesth ; 123(3): 269-287, 2019 Sep.
Article in En | MEDLINE | ID: mdl-31351590
BACKGROUND: Evidence-based international expert consensus regarding anaesthetic practice in hip/knee arthroplasty surgery is needed for improved healthcare outcomes. METHODS: The International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) systematic review, including randomised controlled and observational studies comparing neuraxial to general anaesthesia regarding major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, genitourinary, thromboembolic, neurological, infectious, and bleeding complications. Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, from 1946 to May 17, 2018 were queried. Meta-analysis and Grading of Recommendations Assessment, Development and Evaluation approach was utilised to assess evidence quality and to develop recommendations. RESULTS: The analysis of 94 studies revealed that neuraxial anaesthesia was associated with lower odds or no difference in virtually all reported complications, except for urinary retention. Excerpt of complications for neuraxial vs general anaesthesia in hip/knee arthroplasty, respectively: mortality odds ratio (OR): 0.67, 95% confidence interval (CI): 0.57-0.80/OR: 0.83, 95% CI: 0.60-1.15; pulmonary OR: 0.65, 95% CI: 0.52-0.80/OR: 0.69, 95% CI: 0.58-0.81; acute renal failure OR: 0.69, 95% CI: 0.59-0.81/OR: 0.73, 95% CI: 0.65-0.82; deep venous thrombosis OR: 0.52, 95% CI: 0.42-0.65/OR: 0.77, 95% CI: 0.64-0.93; infections OR: 0.73, 95% CI: 0.67-0.79/OR: 0.80, 95% CI: 0.76-0.85; and blood transfusion OR: 0.85, 95% CI: 0.82-0.89/OR: 0.84, 95% CI: 0.82-0.87. CONCLUSIONS: Recommendation: primary neuraxial anaesthesia is preferred for knee arthroplasty, given several positive postoperative outcome benefits; evidence level: low, weak recommendation. RECOMMENDATION: neuraxial anaesthesia is recommended for hip arthroplasty given associated outcome benefits; evidence level: moderate-low, strong recommendation. Based on current evidence, the consensus group recommends neuraxial over general anaesthesia for hip/knee arthroplasty. TRIAL REGISTRY NUMBER: PROSPERO CRD42018099935.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Arthroplasty, Replacement, Hip / Arthroplasty, Replacement, Knee / Anesthesia, Epidural / Anesthesia, General / Anesthesia, Spinal Type of study: Clinical_trials / Guideline / Observational_studies / Systematic_reviews Limits: Humans Language: En Journal: Br J Anaesth Year: 2019 Type: Article
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Arthroplasty, Replacement, Hip / Arthroplasty, Replacement, Knee / Anesthesia, Epidural / Anesthesia, General / Anesthesia, Spinal Type of study: Clinical_trials / Guideline / Observational_studies / Systematic_reviews Limits: Humans Language: En Journal: Br J Anaesth Year: 2019 Type: Article