Abstract
Introduction
Enhanced recovery programmes (ERP) have recently been adopted in the UK, enabling patients to recover quickly and return home sooner. Choice of anaesthetic is an important factor effecting post-operative outcome; studies show regional anaesthesia is more cost-effective, decreasing the incidence of venous thromboembolic events and reducing intra-operative blood loss, the need for transfusion and the length of hospital stay.
Objectives
The objective of this study was to compare the short-term outcome of patients enrolled in our ERP who underwent either general or spinal +/− epidural anaesthesia.
Methods
We prospectively studied 1222 patients (age- and sex-matched) who underwent lower limb arthroplasty enrolled in our ERP between March 2010-December 2011. Patients were given the opportunity to discuss their preferred mode of anaesthesia with their anaesthetist. Group 1 underwent general anaesthesia (GA), Group 2 underwent spinal +/− epidural anaesthesia (SA+/−EA).
Results
1222 patients underwent lower limb arthroplasty during our study period; 690 patients underwent GA, and 532 patients received SA+/−EA. There were similar ratios of THRs and TKRs in each group 343:347 and 257:275, respectively. Group 1 had an average age of 67.8 years (range 23–92; 65% female, 35% male), group 2 average age was 70 years (range 29–96; 58% female, 42% male). Average length of stay was 4.65 days in group 1 and 4.75 days in group 2 (Median 4, range 1–23). Similar rates of post-operative wound complications were noted in each group. Both groups had just two incidences of venous thromboembolic events.
Conclusion
Enhanced Recovery Programmes have been initiated to reduce hospital stay following lower limb arthroplasty. We have shown no statistically significant difference between the patient being asleep or awake during surgery in the short-term outcome following surgery. The biggest contributing factors to the mode of anaesthesia used were individual anaesthetists' preference and patient choice.
