TY - JOUR
T1 - Anaesthetic care of patients undergoing primary hip and knee arthroplasty
T2 - consensus recommendations from the International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) based on a systematic review and meta-analysis
AU - Memtsoudis, Stavros G.
AU - Cozowicz, Crispiana
AU - Bekeris, Janis
AU - Bekere, Dace
AU - Liu, Jiabin
AU - Soffin, Ellen M.
AU - Mariano, Edward R.
AU - Johnson, Rebecca L.
AU - Hargett, Mary J.
AU - Lee, Bradley H.
AU - Wendel, Pamela
AU - Brouillette, Mark
AU - Go, George
AU - Kim, Sang J.
AU - Baaklini, Lila
AU - Wetmore, Douglas
AU - Hong, Genewoo
AU - Goto, Rie
AU - Jivanelli, Bridget
AU - Argyra, Eriphyli
AU - Barrington, Michael J.
AU - Borgeat, Alain
AU - De Andres, Jose
AU - Elkassabany, Nabil M.
AU - Gautier, Philippe E.
AU - Gerner, Peter
AU - Gonzalez Della Valle, Alejandro
AU - Goytizolo, Enrique
AU - Kessler, Paul
AU - Kopp, Sandra L.
AU - Lavand'Homme, Patricia
AU - MacLean, Catherine H.
AU - Mantilla, Carlos B.
AU - MacIsaac, Daniel
AU - McLawhorn, Alexander
AU - Neal, Joseph M.
AU - Parks, Michael
AU - Parvizi, Javad
AU - Pichler, Lukas
AU - Poeran, Jashvant
AU - Poultsides, Lazaros A.
AU - Sites, Brian D.
AU - Stundner, Otto
AU - Sun, Eric C.
AU - Viscusi, Eugene R.
AU - Votta-Velis, Effrossyni G.
AU - Wu, Christopher L.
AU - Ya Deau, Jacques T.
AU - Sharrock, Nigel E.
N1 - Funding Information:
SGM is a director of the boards of the American Society of Regional Anesthesia and Pain Medicine and the president of the Society of Anesthesia and Sleep Medicine. He is a one-time consultant for Teikoku, Sandoz Inc. and a consultant/investor for HATH. Furthermore, SGM has a US Patent application pending for a Multicatheter Infusion System (US-2017-0361063). He is the owner of SGM Consulting, LLC, and co-owner of FC Monmouth, LLC. None of these relations influenced the conduct of the present project. ERM is a director of the board of the American Society of Regional Anesthesia and Pain Medicine and an officer of the California Society of Anesthesiologists. ERM is also an employee of the United States government, and his contribution to this project is supported with resources based at the Veterans Affairs (VA) Palo Alto Health Care System (Palo Alto, CA, USA). The contents do not represent the views of VA or the United States Government. NE is a board member of the American Society of Regional Anesthesia and Pain Medicine. NE is also a consultant for Foundry Therapeutics, but declared no conflict of interest. ECS reports consulting fees from Egalet, Inc. and the Mission Lisa foundation and acknowledges funding from the National Institute on Drug Abuse (K08DA042314). which are unrelated to this work. The other authors declare that they have no conflicts of interest.Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, New York, NY, USA.
Funding Information:
SGM is a director of the boards of the American Society of Regional Anesthesia and Pain Medicine and the president of the Society of Anesthesia and Sleep Medicine. He is a one-time consultant for Teikoku, Sandoz Inc. and a consultant/investor for HATH. Furthermore, SGM has a US Patent application pending for a Multicatheter Infusion System (US-2017-0361063). He is the owner of SGM Consulting, LLC, and co-owner of FC Monmouth, LLC. None of these relations influenced the conduct of the present project. ERM is a director of the board of the American Society of Regional Anesthesia and Pain Medicine and an officer of the California Society of Anesthesiologists. ERM is also an employee of the United States government, and his contribution to this project is supported with resources based at the Veterans Affairs (VA) Palo Alto Health Care System (Palo Alto, CA, USA). The contents do not represent the views of VA or the United States Government. NE is a board member of the American Society of Regional Anesthesia and Pain Medicine. NE is also a consultant for Foundry Therapeutics, but declared no conflict of interest. ECS reports consulting fees from Egalet, Inc. and the Mission Lisa foundation and acknowledges funding from the National Institute on Drug Abuse ( K08DA042314 ). which are unrelated to this work. The other authors declare that they have no conflicts of interest.
Publisher Copyright:
© 2019 British Journal of Anaesthesia
PY - 2019/9
Y1 - 2019/9
N2 - Background: Evidence-based international expert consensus regarding anaesthetic practice in hip/knee arthroplasty surgery is needed for improved healthcare outcomes. Methods: The International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) systematic review, including randomised controlled and observational studies comparing neuraxial to general anaesthesia regarding major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, genitourinary, thromboembolic, neurological, infectious, and bleeding complications. Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, from 1946 to May 17, 2018 were queried. Meta-analysis and Grading of Recommendations Assessment, Development and Evaluation approach was utilised to assess evidence quality and to develop recommendations. Results: The analysis of 94 studies revealed that neuraxial anaesthesia was associated with lower odds or no difference in virtually all reported complications, except for urinary retention. Excerpt of complications for neuraxial vs general anaesthesia in hip/knee arthroplasty, respectively: mortality odds ratio (OR): 0.67, 95% confidence interval (CI): 0.57–0.80/OR: 0.83, 95% CI: 0.60–1.15; pulmonary OR: 0.65, 95% CI: 0.52–0.80/OR: 0.69, 95% CI: 0.58–0.81; acute renal failure OR: 0.69, 95% CI: 0.59–0.81/OR: 0.73, 95% CI: 0.65–0.82; deep venous thrombosis OR: 0.52, 95% CI: 0.42–0.65/OR: 0.77, 95% CI: 0.64–0.93; infections OR: 0.73, 95% CI: 0.67–0.79/OR: 0.80, 95% CI: 0.76–0.85; and blood transfusion OR: 0.85, 95% CI: 0.82–0.89/OR: 0.84, 95% CI: 0.82–0.87. Conclusions: Recommendation: primary neuraxial anaesthesia is preferred for knee arthroplasty, given several positive postoperative outcome benefits; evidence level: low, weak recommendation. Recommendation: neuraxial anaesthesia is recommended for hip arthroplasty given associated outcome benefits; evidence level: moderate-low, strong recommendation. Based on current evidence, the consensus group recommends neuraxial over general anaesthesia for hip/knee arthroplasty. Trial registry number: PROSPERO CRD42018099935.
AB - Background: Evidence-based international expert consensus regarding anaesthetic practice in hip/knee arthroplasty surgery is needed for improved healthcare outcomes. Methods: The International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) systematic review, including randomised controlled and observational studies comparing neuraxial to general anaesthesia regarding major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, genitourinary, thromboembolic, neurological, infectious, and bleeding complications. Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, from 1946 to May 17, 2018 were queried. Meta-analysis and Grading of Recommendations Assessment, Development and Evaluation approach was utilised to assess evidence quality and to develop recommendations. Results: The analysis of 94 studies revealed that neuraxial anaesthesia was associated with lower odds or no difference in virtually all reported complications, except for urinary retention. Excerpt of complications for neuraxial vs general anaesthesia in hip/knee arthroplasty, respectively: mortality odds ratio (OR): 0.67, 95% confidence interval (CI): 0.57–0.80/OR: 0.83, 95% CI: 0.60–1.15; pulmonary OR: 0.65, 95% CI: 0.52–0.80/OR: 0.69, 95% CI: 0.58–0.81; acute renal failure OR: 0.69, 95% CI: 0.59–0.81/OR: 0.73, 95% CI: 0.65–0.82; deep venous thrombosis OR: 0.52, 95% CI: 0.42–0.65/OR: 0.77, 95% CI: 0.64–0.93; infections OR: 0.73, 95% CI: 0.67–0.79/OR: 0.80, 95% CI: 0.76–0.85; and blood transfusion OR: 0.85, 95% CI: 0.82–0.89/OR: 0.84, 95% CI: 0.82–0.87. Conclusions: Recommendation: primary neuraxial anaesthesia is preferred for knee arthroplasty, given several positive postoperative outcome benefits; evidence level: low, weak recommendation. Recommendation: neuraxial anaesthesia is recommended for hip arthroplasty given associated outcome benefits; evidence level: moderate-low, strong recommendation. Based on current evidence, the consensus group recommends neuraxial over general anaesthesia for hip/knee arthroplasty. Trial registry number: PROSPERO CRD42018099935.
KW - anaesthesia
KW - anaesthesia
KW - anaesthesia
KW - arthroplasty
KW - arthroplasty
KW - assessment
KW - epidural
KW - general
KW - hip
KW - knee
KW - outcomes
KW - replacement
KW - replacement
KW - spinal
UR - http://www.scopus.com/inward/record.url?scp=85069645844&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85069645844&partnerID=8YFLogxK
U2 - 10.1016/j.bja.2019.05.042
DO - 10.1016/j.bja.2019.05.042
M3 - Review article
C2 - 31351590
AN - SCOPUS:85069645844
SN - 0007-0912
VL - 123
SP - 269
EP - 287
JO - British journal of anaesthesia
JF - British journal of anaesthesia
IS - 3
ER -