• Stavros G Memtsoudis, Crispiana Cozowicz, Janis Bekeris, Dace Bekere, Jiabin Liu, Ellen M Soffin, Edward R Mariano, Rebecca L Johnson, Mary J Hargett, Bradley H Lee, Pamela Wendel, Mark Brouillette, George Go, Sang J Kim, Lila Baaklini, Douglas Wetmore, Genewoo Hong, Rie Goto, Bridget Jivanelli, Eriphyli Argyra, Michael J Barrington, Alain Borgeat, Jose De Andres, Nabil M Elkassabany, Philippe E Gautier, Peter Gerner, Gonzalez Della Valle Alejandro A Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery and Department of Anesthesiology, Weill Cor, Enrique Goytizolo, Paul Kessler, Sandra L Kopp, Patricia Lavand'Homme, Catherine H MacLean, Carlos B Mantilla, Daniel MacIsaac, Alexander McLawhorn, Joseph M Neal, Michael Parks, Javad Parvizi, Lukas Pichler, Jashvant Poeran, Lazaros A Poultsides, Brian D Sites, Otto Stundner, Eric C Sun, Eugene R Viscusi, Effrossyni G Votta-Velis, Christopher L Wu, Jacques T Ya Deau, and Nigel E Sharrock.
• 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, Austria. Electronic address: memtsoudiss@hss.edu.
• Br J Anaesth. 2019 Sep 1; 123 (3): 269-287.

BackgroundEvidence-based international expert consensus regarding anaesthetic practice in hip/knee arthroplasty surgery is needed for improved healthcare outcomes.MethodsThe 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.ResultsThe 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.ConclusionsRecommendation: primary neuraxial anaesthesia is preferred for knee arthroplasty, given several positive postoperative outcome benefits; evidence level: low, weak recommendation.Recommendationneuraxial 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 NumberPROSPERO CRD42018099935.Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

26 keywords...

hide…