Impact of general vs. regional anaesthesia on one-year clinical outcomes and healthcare utilisation after lower limb arthroplasty: a retrospective study

Introduction

General anaesthesia and regional anaesthesia are used for hip and knee arthroplasty but their impact on long-term outcomes remains unclear. This study aimed to compare one-year clinical outcomes and healthcare utilisation in patients receiving general or regional anaesthesia for hip or knee arthroplasty.

Methods

Using data from the TriNetX Global Collaborative Network, we conducted a retrospective analysis of 247,142 patients aged 40–90 y who underwent hip or knee arthroplasty between 2010 and 2023. After propensity score matching, 12,558 patients were included in the general anaesthesia and regional anaesthesia cohorts. The primary outcome was one-year all-cause mortality. Secondary outcomes included one-year incidence of dementia; cerebral infarction; pneumonia; major depression; care provider dependency; and readmission rates. Subgroup analyses according to sex, age (40–70 y vs. > 70 y) and timeframe (2010–2016 vs. 2017–2023) were also performed.

Results

There was no significant difference in one-year mortality (hazard ratio 1.12, 95%CI 0.89–1.41, p = 0.322). General anaesthesia was associated with a lower incidence of major depression (hazard ratio 0.82, 95%CI 0.70–0.97, p = 0.021) and care provider dependency (hazard ratio 0.47, 95%CI 0.38–0.58, p < 0.001), but higher readmission rates (hazard ratio 1.22, 95%CI 1.16–1.29, p < 0.001) than regional anaesthesia. Subgroup analysis revealed that patient characteristics including sex and age, as well as evolving peri-operative care practices over time, may influence the comparative outcomes of general and regional anaesthesia in patients undergoing elective hip or knee arthroplasty.

Discussion

Although general anaesthesia and regional anaesthesia showed comparable one-year mortality, general anaesthesia was associated with lower risks of major depression and care provider dependency but higher readmission rates than regional anaesthesia. These findings suggest that the choice of anaesthesia may have important implications for long-term outcomes beyond mortality.