SummaryIntroductionGeneral anaesthesia and regional anaesthesia are used for hip and knee arthroplasty but their impact on long‐term outcomes remains unclear. This study aimed to compare one‐year clinical outcomes and healthcare utilisation in patients receiving general or regional anaesthesia for hip or knee arthroplasty.MethodsUsing data from the TriNetX Global Collaborative Network, we conducted a retrospective analysis of 247,142 patients aged 40–90 y who underwent hip or knee arthroplasty between 2010 and 2023. After propensity score matching, 12,558 patients were included in the general anaesthesia and regional anaesthesia cohorts. The primary outcome was one‐year all‐cause mortality. Secondary outcomes included one‐year incidence of dementia; cerebral infarction; pneumonia; major depression; care provider dependency; and readmission rates. Subgroup analyses according to sex, age (40–70 y vs. > 70 y) and timeframe (2010–2016 vs. 2017–2023) were also performed.ResultsThere was no significant difference in one‐year mortality (hazard ratio 1.12, 95%CI 0.89–1.41, p = 0.322). General anaesthesia was associated with a lower incidence of major depression (hazard ratio 0.82, 95%CI 0.70–0.97, p = 0.021) and care provider dependency (hazard ratio 0.47, 95%CI 0.38–0.58, p < 0.001), but higher readmission rates (hazard ratio 1.22, 95%CI 1.16–1.29, p < 0.001) than regional anaesthesia. Subgroup analysis revealed that patient characteristics including sex and age, as well as evolving peri‐operative care practices over time, may influence the comparative outcomes of general and regional anaesthesia in patients undergoing elective hip or knee arthroplasty.DiscussionAlthough general anaesthesia and regional anaesthesia showed comparable one‐year mortality, general anaesthesia was associated with lower risks of major depression and care provider dependency but higher readmission rates than regional anaesthesia. These findings suggest that the choice of anaesthesia may have important implications for long‐term outcomes beyond mortality.

中文翻译：

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全身麻醉与区域麻醉对下肢关节置换术后 1 年临床结局和医疗保健利用的影响：一项回顾性研究


摘要简介全身麻醉和区域麻醉用于髋关节和膝关节置换术，但它们对长期结局的影响尚不清楚。本研究旨在比较接受髋关节或膝关节置换术全身麻醉或区域麻醉的患者的一年临床结局和医疗保健利用情况。方法使用来自 TriNetX 全球协作网络的数据，我们对 2010 年至 2023 年间接受髋关节或膝关节置换术的 247,142 名年龄在 40-90 岁之间的患者进行了回顾性分析。倾向评分匹配后，12,558 例患者被纳入全身麻醉和区域麻醉队列。主要结局是 1 年全因死亡率。次要结局包括痴呆一年发病率;脑梗塞;肺炎;重度抑郁症;护理提供者依赖性;和再入院率。还根据性别、年龄 （40-70 岁 vs. > 70 岁） 和时间范围 （2010-2016 年与 2017-2023 年） 进行了亚组分析。结果一年死亡率无显著差异 （风险比 1.12,95% CI 0.89-1.41，p = 0.322）。全身麻醉与重度抑郁症 （风险比 0.82,95%CI 0.70-0.97，p = 0.021） 和护理提供者依赖 （风险比 0.47,95%CI 0.38-0.58，p < 0.001） 的发生率较低相关，但再入院率较高 （风险比 1.22,95%CI 1.16-1.29，p < 0.001） 比区域麻醉。亚组分析显示，患者特征（包括性别和年龄）以及随着时间的推移不断发展的围手术期护理实践，可能会影响接受择期髋关节或膝关节置换术患者全身麻醉和区域麻醉的比较结果。讨论尽管全身麻醉和区域麻醉的 1 年死亡率相当，但全身麻醉与重度抑郁和护理提供者依赖性风险较低相关，但与区域麻醉相比，再入院率更高。这些发现表明，麻醉的选择可能对死亡率以外的长期结局具有重要影响。