Spinal Versus General Anesthesia for Patients Undergoing Outpatient Total Knee Arthroplasty

A National Propensity Matched Analysis of Early Postoperative Outcomes

Mark C. Kendall; Alexander D. Cohen; Stephanie Principe-Marrero; Peter Sidhom; Patricia Apruzzese; Gildasio De Oliveira


BMC Anesthesiol. 2021;21(226) 

In This Article


The demand for total knee arthroplasty (TKA) is expected to increase exponentially by 2050, and healthcare systems are exploring strategies to meet this demand in a safe and cost-effective manner.[1,2] This has resulted in significantly more TKA procedures being performed on an outpatient basis in selected patients.[3] The shift from inpatient to outpatient TKA has significant potential of cost savings for health care systems and government payers (e.g., Medicare).[4]

Postoperative adverse events in patients undergoing TKA may increase the probability of disability and affect the quality of recovery. Previous investigations have reported the adverse events and serious adverse events ranging from 1 month to several years in duration.[5–7] Patients in the ambulatory setting cannot rely on hospital support (e.g., nurses, intravenous medications) to manage their postoperative recovery and are expected to provide self-care after surgery.[8] The type of anesthetic plan, general versus spinal anesthesia has been shown to influence the postoperative outcomes in patients undergoing TKA surgery.

The purpose of this study is to compare the association between spinal versus general anesthesia on early postoperative outcomes in patients undergoing outpatient TKAs using the most up-to-date sample from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. We hypothesized that patients undergoing outpatient TKA under spinal anesthesia would have a lower rate of serious postoperative complications when compared to patients receiving general anesthesia. In addition, we sought to compare readmission rates between the two anesthesia techniques.