British Journal of Anaesthesia, 123 (3): 269-287 (2019)
Total joint arthroplasty (TJA) is amongst the most commonly performed surgical procedures in the developed world.1 Globally, millions of patients receive total hip and knee arthroplasties every year with large projected increases as the population ages.2 Despite the fact that TJA represents a valuebased solution to end-stage arthritis of the hip and knee,3 the procedure is associated with a moderate risk for complications. Complications affecting major organ systems have been reported to occur in approximately 8% of patients undergoing either hip or knee arthroplasty.4 The identification of risk-modifying perioperative interventions represents an attractive target, given the large burden of resources required for the management of complications on a population-health level.
In this context, a number of recently published populationbased studies have supported findings of earlier clinical trials, indicating that the type of anaesthetic technique may influence perioperative outcomes.5,6 Whilst earlier RCTs suggested a potential benefit of neuraxial anaesthesia (NA) for outcomes, such as blood loss and thromboembolic events, these investigations were not sufficiently powered to study lowincidence outcomes, such as mortality, infectious, or cardiovascular complications.7 Read More
