Regional-Only Versus General Anesthesia For Total Shoulder Arthroplasty
Adil Shahzad Ahmed, M.D.1, Abdullah Naser Ghali, M.D.1, David Momtaz, B.S., M.P.H.2, Aaron Singh, B.A.2, Zuhair Jameel Mohammed, B.A.1 and Valeria Cristina De Las Casas, B.A.1, (1)Baylor College of Medicine, Houston, TX, (2)UT Health San Antonio, San Antonio, TX
Introduction: The number of total shoulder arthroplasties (TSA) performed annually is rapidly rising. Improvements in techniques, implant technology, and outcomes have resulted in expanded indications for arthroplasty over the past several decades. Still, an impediment for some patients is general anesthesia, the most common modality used in this setting. However, regional anesthesia is a potential alternative for those with either contraindication or aversion to general anesthesia. The aim of this study is to compare outcomes of general versus regional-only anesthesia in the setting of TSA.
Methods: This was a retrospective cohort study. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database, years 2016-2020, was queried by CPT code for all patients undergoing TSA. Patients were stratified by anesthesia modality, general or regional-only, and multivariate regression was performed to compare postoperative outcomes. Comorbidities and baseline demographic differences were controlled in the regression.
Results: A total of 32,718 patients underwent TSA, with 512 (1.56%) receiving regional-only anesthesia. Regional-only anesthesia was associated with reduced odds of any complication (OR 0.683; p<0.001). Specifically, odds of postoperative pneumonia were decreased for regional-only group (OR 0.581; p<0.001). Notably, we found that length of stay was significantly less in patients receiving regional only anesthesia (a mean of 1.2 days versus 1.5 days for those receiving general anesthesia; p<0.001); however, we found no significant difference in delayed hospital stays (stays greater than 3 days).
Conclusion: Regional anesthesia is a viable option in TSA and does not appear to pose any elevated risk compared to general. In fact, it may reduce overall risks of complications, particularly pulmonary etiologies such as pneumonia. Although general anesthesia is far more common, orthopedic surgeons should be cognizant of alternate options and the potential benefits of regional anesthesia in the setting of TSA.
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