TOPLINE

Among patients who underwent major orthopedic surgery, those who received regional and general anesthesia had slightly better daily function at discharge, shorter stays in the hospital, and lower in-hospital death than those who received general anesthesia alone.

METHODOLOGY

• Researchers emulated a target trial using hospital claims data to assess whether adding regional anesthesia to general anesthesia was linked to improved activities of daily living after major orthopedic surgery.
• They analyzed 679,674 admissions of adults for orthopedic surgery (excluding spine procedures) in Japan between 2016 and 2023.
• Patients were grouped into those who received general anesthesia alone (n = 435,462) or those who received both, including peripheral nerve blocks and epidural anesthesia (n = 244,212).
• The primary outcome was a change in scores of the Barthel Index (0-100), a 10-item scale measuring basic daily activities, with higher scores indicating greater independence.
• Secondary outcomes were the length of stay after surgery and rates of in-hospital mortality at 28 days.

TAKEAWAY

• Patients who received both general and regional anesthesia showed a 0.73-point greater improvement in scores from admission to discharge, and a 1.40-day shorter hospital stay after surgery than those who received general anesthesia alone (P < .001 for both).
• Combined anesthesia was associated with a 15% lower risk for in-hospital death at 28 days than general anesthesia (P = .006).
• Adding epidural anesthesia or peripheral nerve blocks to general anesthesia was associated with greater improvement in scores than general anesthesia alone, with a larger benefit with epidural anesthesia.

IN PRACTICE

“Residual confounding and heterogeneity of regional anesthesia techniques warrant cautious interpretation and prospective confirmation,” the authors of the study wrote.

SOURCE

The study was led by Manabu Yoshimura of Ube Central Hospital in Ube, Japan. It was published online on July 17 in the British Journal of Anaesthesia.

LIMITATIONS

The claims data did not capture frailty, cognitive status at baseline, or the intensity of rehabilitation. Researchers lacked detailed information about the combination. The Barthel Index at discharge may have been affected by the timing of discharge and hospital practices.

DISCLOSURES

No funding information was provided in the article. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.