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Difference in short-term comlication between sipnal and general anesthesia for Primary TKA Andrew J pugely MD University of Iowa Hospital
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Background Spinal anesthesia lower incidence of DVT shorter oprative time less blood loss General anesthesia worse performance in morbidity and mortality
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Purpose Identify difference between two mothods Compare the mobidity and mortality in 30d
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Methods Database From ACS NSQIP Between 2005 and 2010 SA 6030 GA 8022 Objective Patient characteristics 30D compication rates mortality Statistics Multivariate logistic regression
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Results 14052 cases 42.9% under spinal anesthesia(SA) 57.1% under general anesthesia(GA) SA(unadjusted) - lower frequency superficial wound infection the length of surgery the length of hospital stay GA(adjusted confouders) Higher likelihood of complications
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Preoperative comorbidities Age/female/black race/elevated creatinine/ ASAC/operative time /anesthesia choice/ are independent risk factors Results
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Conclusion patients managed with GA had a small but significant increase in the risk of complications patients especially with multiple comorbidities may consider spinal anesthesia
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TIPS 1 Spinal anesthesia increased potential for paresthesias neurologic injury a few articles demostated no significant difference between SA and GA limited by small patient numbers no multicenter prospective comparison
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ACS NSQIP National surgical quality improvement program this database was widely used to investigate short-term outcomes ecch participanting institution collect morbidity and mortality data on each patient data collection continue on outpatients the overall disagreement < 1.8% NSQIP has strict definitions for each complication user guide TIPS 2
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Complication following TKA surgical site infection/wound dehiscence/pe/ dvt/respiration/renal failure/myocardial infarcion/stoke/coma/never injury/urinary infection/sepsis/return within 30D/ more frequency urinary tract infection/reoperation/blood transfusion TIPS 3
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Patients characteristic Divided to 4 parts Demographic characteristic(age sex race) Preoperative comorbidity(chronic diseases) Preoperative lab values Operative variable (ASA class/blood tranfusion,time of surgery ) TIPS 4
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Discussion the difference between two mothods <1% the importance is likely low greatest difference in patients with highest number of comorbidities
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Discussion database is not orthopaedic specific 7% 30D short-term spinal anethesis more prevalent at good hospital prospective study,no randomized
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Discussion large number(258 hospitals in usa) Database-based analyses
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