Spinal Anesthesia in Total Hip Arthroplasty is Associated With Improved Outcomes in the American Joint Replacement Registry Population

Background: Despite previous studies showing benefits of spinal anesthesia (SA) for patients undergoing elective total hip arthroplasty (THA), most THA procedures throughout the United States still utilize general anesthesia (GA). Using the American Joint Replacement Registry data, our study explored outcome difference for patients undergoing THA administered SA vs GA. Methods: All available THAs were identified using American Joint Replacement Registry data from 2017 to 2020. THA patients were categorized into 2 cohorts by anesthesia type. Demographics, hospital characteristics, and comorbidities were documented for each patient. Outcomes included operative time, length of stay, 30- and 90-day readmission, and 90-day all-cause revision. Chi-square analysis was used to assess categorical variables while multivariable regression analyzed the association between anesthesia type and outcomes of interest. Results: A total of 217,124 THAs were identified, including 119,425 (55.0%) patients who received GA and 97,699 (45.0%) patients who received SA. Multivariable regression showed that SA was associated with a decreased risk of hospital length of stay >3 days (adjusted odds ratio [aOR] 0.4, 95% confidence interval [CI]: 0.34-0.36, P < .0001) and a lower likelihood of prolonged operative time (aOR 0.8, 95% CI: 0.79-0.82, P < .0001). Additionally, patients who received SA had lower rates of 90-day readmission (aOR 0.7, 95% CI: 0.67-0.78, P < .0001) and a decreased risk of 90-day all-cause revision (aOR 0.5, 95% CI: 0.47-0.54, P < .0001). Conclusions: Patients receiving SA during THA had shorter operative time, reduced length of stay, and decreased rates of readmission and revision compared to patients who received GA. These findings add to the growing body of literature supporting the benefits of SA over GA for THA patients. (c) 2024 Published by Elsevier Inc. on behalf of The American Association of Hip and Knee Surgeons. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/ 4.0/).