Evaluation of Anesthetic Techniques in Outpatient Total Joint Replacement Surgery in an Integrated Health Care Delivery System

Study Overview
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Brief Summary
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The study is a retrospective cohort study of adult patients undergoing outpatient primary unilateral total knee or total hip replacement surgeries from 2017 to 2019 assessing for difference in anesthetic techniques and outcomes.

Detailed Description
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The study is a retrospective cohort study of adult patients undergoing outpatient primary unilateral total knee or total hip replacement surgeries from 2017 to 2019. The purpose of the study is to evaluate the effects of anesthetic techniques for primary total joint replacement in Northern California Kaiser Permanente. The primary objective is to determine if there are clinically and statistically significant differences between the outcomes of general anesthesia and neuraxial anesthesia.

Official Title
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Evaluation of Anesthetic Techniques in Outpatient Total Joint Replacement Surgery in an Integrated Health Care Delivery System

Conditions
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Anesthesia Morbidity, Osteoarthritis, Knee, Osteoarthritis, Hip

Intervention / Treatment
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* Procedure: Anesthesia Type


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA 1 - IV patients Age > 18 Primary total hip/knee replacement Exclusion Criteria: Total joint replacement for oncologic tumors Emergent surgery Age < 17 Pregnant Female Neuraxial anesthesia conversion to general anesthesia Revision total joint replacement Bilateral total joint replacement

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Total Joint Arthroplasty<br>The cohort includes patients undergoing outpatient primary total joint replacement surgeries from 2017 to 2019. Primary total joint surgery is defined as patients who undergo unilateral total knee replacement or total hip replacement for the first time during the study years | Procedure: Anesthesia Type<br>* The anesthetic type either general anesthesia or neuraxial anesthesia is the intervention type for patients undergoing primary total joint arthroplasty of the knee or hip.<br>* Other names: Anesthetic Technique;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative Morbidity | 30-day Postoperative Morbidity including surgical site infection (defined as infection involving the skin or subcutaneous tissue of the incision, deep incisional infection defined as infected tissue below the subcutaneous tissue including fascia and muscle), major coronary events (defined as nonfatal myocardial infarction, heart failure, ventricular tachycardia, cardiac arrest), pneumonia, urinary tract infection, venous thromboembolism, pulmonary embolism, cerebrovascular accident, renal injury/failure (Defined as increase in baseline creatinine 2 fold/3fold respectively). | 30-day postoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative Mortality | 30-day postoperative mortality - all cause | 30-day postoperative | 
| Postoperative readmission | 30-day postoperative readmission - all cause | 30-day postoperative | 
| Intraoperative blood loss and transfusion rates | Measurement of blood loss by mL recorded on record. Measurement of packed red blood cells transfused by unit pack. | Day of surgery | 
| Intraoperative opioid use | Defined by type of analgesic medication and total morphine equivalence | Day of surgery | 
| Postoperative opioid use | Defined by type of analgesic medication and total morphine equivalence | Day of surgery | 
| Postoperative Pain Scores | Numerical Rating Scale of postsurgical pain measured until discharge from hospital. Numerical rating scale for pain is described as a scale from a minimum of 0, associated with no pain, to a maximum of 10, associated with the worst possible pain. A higher number is associated with a worse outcome. | Day of surgery | 
| Postoperative nausea and vomiting | Rate of PONV after surgery | Day of surgery | 
| Length of postsurgical hospital stay | Length of time defined from end of intraoperative time to discharge from hospital time | Day of surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Retrospective Cohort, Anesthetic Technique, Total Joint Arthroplasty