Anesthesia practice among joint arthroplasty patients with a previous lumbar spine surgery

Study objective: To analyze the use of neuraxial techniques in total hip or knee arthroplasty patients who pre-viously underwent lumbar spine surgeries.Design: Retrospective analysis of a national database.Setting: U.S. hospitals.Patients: Patients undergoing a total hip or knee arthroplasty, stratified by those with a previous lumbar fusion or decompression procedure.Measurements: Our 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 results: Among 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 & LE;0.0001) and TKA (OR: 0.80 CI: 0.77-0.84, p & LE;0.0001).Conclusions: Previous lumbar fusion-but not decompression-surgery is associated with lower neuraxial anes-thesia 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.