1. Difference in short-term comlication between sipnal and general anesthesia for Primary TKA Andrew J pugely MD University of Iowa Hospital

2. Background  Spinal anesthesia lower incidence of DVT shorter oprative time less blood loss  General anesthesia worse performance in morbidity and mortality

3. Purpose  Identify difference between two mothods  Compare the mobidity and mortality in 30d

4. Methods  Database From ACS NSQIP Between 2005 and 2010 SA 6030 GA 8022  Objective Patient characteristics 30D compication rates mortality  Statistics Multivariate logistic regression

5. 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

6.  Preoperative comorbidities  Age/female/black race/elevated creatinine/ ASAC/operative time /anesthesia choice/ are independent risk factors Results

7. 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

8. 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

9.  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

10.  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

11.  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

12. Discussion  the difference between two mothods <1%  the importance is likely low  greatest difference in patients with highest number of comorbidities

13. Discussion  database is not orthopaedic specific 7%  30D short-term  spinal anethesis more prevalent at good hospital  prospective study,no randomized

14. Discussion  large number(258 hospitals in usa)  Database-based analyses