General Anesthesia Leads to Increased Adverse Events Compared to Spinal Anesthesia in Patients Undergoing Unicompartmental Knee Arthroplasty

Abstract Background The volume of unicompartmental knee arthroplasty (UKA) has increased dramatically in recent years with good reported long-term outcomes. UKA can be performed under general or neuraxial (ie spinal) anesthesia, however, little is known as to whether there is a difference in outcomes based on anesthesia type. The purpose of the current study is to compare perioperative outcomes between anesthesia types for patients undergoing primary elective UKA. Methods Patients who underwent primary elective UKA from 2007 to 2017 were identified from the American College of Surgeons National Surgical Quality Improvement Program Database (ACS-NSQIP). Operating room times, length of stay, thirty-day adverse events, and readmission rates were compared between patients who received general anesthesia and those who received spinal anesthesia. Propensity-adjusted multivariate analysis was used to control for selection bias and baseline patient characteristics. Results A total of 8,639 patients underwent UKA and met the inclusion criteria for this study. Of these, 4,728 patients (54.7%) received general anesthesia and 3,911 patients (45.3%) received spinal anesthesia. On propensity-adjusted multivariate analyses, general anesthesia was associated with increased operative time (p Conclusions General anesthesia was associated with an increased rate of adverse events and increased operating room times as well as a reduced likelihood of discharge to home. There was no difference in hospital length of stay or postoperative readmission rates between anesthesia types. Level of Evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.