• Alex Illescas, Haoyan Zhong, Crispiana Cozowicz, Jashvant Poeran, Stavros G Memtsoudis, and Jiabin Liu.
• Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA.
• J Clin Anesth. 2023 Nov 1; 90: 111222111222.

Study ObjectiveTo analyze the use of neuraxial techniques in total hip or knee arthroplasty patients who previously underwent lumbar spine surgeries.DesignRetrospective analysis of a national database.SettingU.S. hospitals.PatientsPatients undergoing a total hip or knee arthroplasty, stratified by those with a previous lumbar fusion or decompression procedure.MeasurementsOur primary outcome was the use of neuraxial anesthesia; secondary outcomes included combined complications, cardio-pulmonary complications, and prolonged length of stay. Patients with and without a history of a lumbar procedure were compared using mixed-effects regression.Main ResultsAmong 758,857 THAs 8961 had a history of lumbar fusion and 8599 of decompression. Among 1,387,335 TKAs 15,827 had a history of lumbar fusion and 13,652 of decompression. History of a lumbar fusion was associated with lower odds of neuraxial anesthesia use in THA (OR: 0.74 CI: 0.70-0.79, p ≤0.0001) and TKA (OR: 0.80 CI: 0.77-0.84, p ≤0.0001).ConclusionsPrevious lumbar fusion -but not decompression- surgery is associated with lower neuraxial anesthesia in THA/TKA patients, despite its use being universally associated with decreased length of stay. More research is needed to address the importance of neuraxial techniques in patients with prior spine surgery.Copyright © 2023 Elsevier Inc. All rights reserved.

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