Anaesthetic care of patients undergoing primary hip and knee arthroplasty: consensus recommendations from the International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) based on a systematic review and meta-analysis

Stavros G. Memtsoudis, Crispiana Cozowicz, Janis Bekeris, Dace Bekere, Jiabin Liu, Ellen M. Soffin, Edward R. Mariano, Rebecca L. Johnson, Mary J. Hargett, Bradley H. Lee, Pamela Wendel, Mark Brouillette, George Go, Sang J. Kim, Lila Baaklini, Douglas Wetmore, Genewoo Hong, Rie Goto, Bridget Jivanelli, Eriphyli ArgyraMichael J. Barrington, Alain Borgeat, Jose De Andres, Nabil M. Elkassabany, Philippe E. Gautier, Peter Gerner, Alejandro Gonzalez Della Valle, Enrique Goytizolo, Paul Kessler, Sandra L. Kopp, Patricia Lavand'Homme, Catherine H. MacLean, Carlos B. Mantilla, Daniel MacIsaac, Alexander McLawhorn, Joseph M. Neal, Michael Parks, Javad Parvizi, Lukas Pichler, Jashvant Poeran, Lazaros A. Poultsides, Brian D. Sites, Otto Stundner, Eric C. Sun, Eugene R. Viscusi, Effrossyni G. Votta-Velis, Christopher L. Wu, Jacques T. Ya Deau, Nigel E. Sharrock

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Background: Evidence-based international expert consensus regarding anaesthetic practice in hip/knee arthroplasty surgery is needed for improved healthcare outcomes. Methods: The International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) systematic review, including randomised controlled and observational studies comparing neuraxial to general anaesthesia regarding major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, genitourinary, thromboembolic, neurological, infectious, and bleeding complications. Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, from 1946 to May 17, 2018 were queried. Meta-analysis and Grading of Recommendations Assessment, Development and Evaluation approach was utilised to assess evidence quality and to develop recommendations. Results: The analysis of 94 studies revealed that neuraxial anaesthesia was associated with lower odds or no difference in virtually all reported complications, except for urinary retention. Excerpt of complications for neuraxial vs general anaesthesia in hip/knee arthroplasty, respectively: mortality odds ratio (OR): 0.67, 95% confidence interval (CI): 0.57–0.80/OR: 0.83, 95% CI: 0.60–1.15; pulmonary OR: 0.65, 95% CI: 0.52–0.80/OR: 0.69, 95% CI: 0.58–0.81; acute renal failure OR: 0.69, 95% CI: 0.59–0.81/OR: 0.73, 95% CI: 0.65–0.82; deep venous thrombosis OR: 0.52, 95% CI: 0.42–0.65/OR: 0.77, 95% CI: 0.64–0.93; infections OR: 0.73, 95% CI: 0.67–0.79/OR: 0.80, 95% CI: 0.76–0.85; and blood transfusion OR: 0.85, 95% CI: 0.82–0.89/OR: 0.84, 95% CI: 0.82–0.87. Conclusions: Recommendation: primary neuraxial anaesthesia is preferred for knee arthroplasty, given several positive postoperative outcome benefits; evidence level: low, weak recommendation. Recommendation: neuraxial anaesthesia is recommended for hip arthroplasty given associated outcome benefits; evidence level: moderate-low, strong recommendation. Based on current evidence, the consensus group recommends neuraxial over general anaesthesia for hip/knee arthroplasty. Trial registry number: PROSPERO CRD42018099935.

Original languageEnglish (US)
Pages (from-to)269-287
Number of pages19
JournalBritish journal of anaesthesia
Volume123
Issue number3
DOIs
StatePublished - Sep 2019

Fingerprint

Knee Replacement Arthroplasties
Anesthetics
Meta-Analysis
Hip
Patient Care
Anesthesia
Odds Ratio
Confidence Intervals
General Anesthesia
Databases
Lung
Urinary Retention
Mortality
Acute Kidney Injury
PubMed
Venous Thrombosis
Blood Transfusion
Arthroplasty
Libraries
Cost-Benefit Analysis

Keywords

  • anaesthesia
  • anaesthesia
  • anaesthesia
  • arthroplasty
  • arthroplasty
  • assessment
  • epidural
  • general
  • hip
  • knee
  • outcomes
  • replacement
  • replacement
  • spinal

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Anaesthetic care of patients undergoing primary hip and knee arthroplasty : consensus recommendations from the International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) based on a systematic review and meta-analysis. / Memtsoudis, Stavros G.; Cozowicz, Crispiana; Bekeris, Janis; Bekere, Dace; Liu, Jiabin; Soffin, Ellen M.; Mariano, Edward R.; Johnson, Rebecca L.; Hargett, Mary J.; Lee, Bradley H.; Wendel, Pamela; Brouillette, Mark; Go, George; Kim, Sang J.; Baaklini, Lila; Wetmore, Douglas; Hong, Genewoo; Goto, Rie; Jivanelli, Bridget; Argyra, Eriphyli; Barrington, Michael J.; Borgeat, Alain; De Andres, Jose; Elkassabany, Nabil M.; Gautier, Philippe E.; Gerner, Peter; Gonzalez Della Valle, Alejandro; Goytizolo, Enrique; Kessler, Paul; Kopp, Sandra L.; Lavand'Homme, Patricia; MacLean, Catherine H.; Mantilla, Carlos B.; MacIsaac, Daniel; McLawhorn, Alexander; Neal, Joseph M.; Parks, Michael; Parvizi, Javad; Pichler, Lukas; Poeran, Jashvant; Poultsides, Lazaros A.; Sites, Brian D.; Stundner, Otto; Sun, Eric C.; Viscusi, Eugene R.; Votta-Velis, Effrossyni G.; Wu, Christopher L.; Ya Deau, Jacques T.; Sharrock, Nigel E.

In: British journal of anaesthesia, Vol. 123, No. 3, 09.2019, p. 269-287.

Research output: Contribution to journalReview article

Memtsoudis, SG, Cozowicz, C, Bekeris, J, Bekere, D, Liu, J, Soffin, EM, Mariano, ER, Johnson, RL, Hargett, MJ, Lee, BH, Wendel, P, Brouillette, M, Go, G, Kim, SJ, Baaklini, L, Wetmore, D, Hong, G, Goto, R, Jivanelli, B, Argyra, E, Barrington, MJ, Borgeat, A, De Andres, J, Elkassabany, NM, Gautier, PE, Gerner, P, Gonzalez Della Valle, A, Goytizolo, E, Kessler, P, Kopp, SL, Lavand'Homme, P, MacLean, CH, Mantilla, CB, MacIsaac, D, McLawhorn, A, Neal, JM, Parks, M, Parvizi, J, Pichler, L, Poeran, J, Poultsides, LA, Sites, BD, Stundner, O, Sun, EC, Viscusi, ER, Votta-Velis, EG, Wu, CL, Ya Deau, JT & Sharrock, NE 2019, 'Anaesthetic care of patients undergoing primary hip and knee arthroplasty: consensus recommendations from the International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) based on a systematic review and meta-analysis', British journal of anaesthesia, vol. 123, no. 3, pp. 269-287. https://doi.org/10.1016/j.bja.2019.05.042
Memtsoudis, Stavros G. ; Cozowicz, Crispiana ; Bekeris, Janis ; Bekere, Dace ; Liu, Jiabin ; Soffin, Ellen M. ; Mariano, Edward R. ; Johnson, Rebecca L. ; Hargett, Mary J. ; Lee, Bradley H. ; Wendel, Pamela ; Brouillette, Mark ; Go, George ; Kim, Sang J. ; Baaklini, Lila ; Wetmore, Douglas ; Hong, Genewoo ; Goto, Rie ; Jivanelli, Bridget ; Argyra, Eriphyli ; Barrington, Michael J. ; Borgeat, Alain ; De Andres, Jose ; Elkassabany, Nabil M. ; Gautier, Philippe E. ; Gerner, Peter ; Gonzalez Della Valle, Alejandro ; Goytizolo, Enrique ; Kessler, Paul ; Kopp, Sandra L. ; Lavand'Homme, Patricia ; MacLean, Catherine H. ; Mantilla, Carlos B. ; MacIsaac, Daniel ; McLawhorn, Alexander ; Neal, Joseph M. ; Parks, Michael ; Parvizi, Javad ; Pichler, Lukas ; Poeran, Jashvant ; Poultsides, Lazaros A. ; Sites, Brian D. ; Stundner, Otto ; Sun, Eric C. ; Viscusi, Eugene R. ; Votta-Velis, Effrossyni G. ; Wu, Christopher L. ; Ya Deau, Jacques T. ; Sharrock, Nigel E. / Anaesthetic care of patients undergoing primary hip and knee arthroplasty : consensus recommendations from the International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) based on a systematic review and meta-analysis. In: British journal of anaesthesia. 2019 ; Vol. 123, No. 3. pp. 269-287.
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title = "Anaesthetic care of patients undergoing primary hip and knee arthroplasty: consensus recommendations from the International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) based on a systematic review and meta-analysis",
abstract = "Background: Evidence-based international expert consensus regarding anaesthetic practice in hip/knee arthroplasty surgery is needed for improved healthcare outcomes. Methods: The International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) systematic review, including randomised controlled and observational studies comparing neuraxial to general anaesthesia regarding major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, genitourinary, thromboembolic, neurological, infectious, and bleeding complications. Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, from 1946 to May 17, 2018 were queried. Meta-analysis and Grading of Recommendations Assessment, Development and Evaluation approach was utilised to assess evidence quality and to develop recommendations. Results: The analysis of 94 studies revealed that neuraxial anaesthesia was associated with lower odds or no difference in virtually all reported complications, except for urinary retention. Excerpt of complications for neuraxial vs general anaesthesia in hip/knee arthroplasty, respectively: mortality odds ratio (OR): 0.67, 95{\%} confidence interval (CI): 0.57–0.80/OR: 0.83, 95{\%} CI: 0.60–1.15; pulmonary OR: 0.65, 95{\%} CI: 0.52–0.80/OR: 0.69, 95{\%} CI: 0.58–0.81; acute renal failure OR: 0.69, 95{\%} CI: 0.59–0.81/OR: 0.73, 95{\%} CI: 0.65–0.82; deep venous thrombosis OR: 0.52, 95{\%} CI: 0.42–0.65/OR: 0.77, 95{\%} CI: 0.64–0.93; infections OR: 0.73, 95{\%} CI: 0.67–0.79/OR: 0.80, 95{\%} CI: 0.76–0.85; and blood transfusion OR: 0.85, 95{\%} CI: 0.82–0.89/OR: 0.84, 95{\%} CI: 0.82–0.87. Conclusions: Recommendation: primary neuraxial anaesthesia is preferred for knee arthroplasty, given several positive postoperative outcome benefits; evidence level: low, weak recommendation. Recommendation: neuraxial anaesthesia is recommended for hip arthroplasty given associated outcome benefits; evidence level: moderate-low, strong recommendation. Based on current evidence, the consensus group recommends neuraxial over general anaesthesia for hip/knee arthroplasty. Trial registry number: PROSPERO CRD42018099935.",
keywords = "anaesthesia, anaesthesia, anaesthesia, arthroplasty, arthroplasty, assessment, epidural, general, hip, knee, outcomes, replacement, replacement, spinal",
author = "Memtsoudis, {Stavros G.} and Crispiana Cozowicz and Janis Bekeris and Dace Bekere and Jiabin Liu and Soffin, {Ellen M.} and Mariano, {Edward R.} and Johnson, {Rebecca L.} and Hargett, {Mary J.} and Lee, {Bradley H.} and Pamela Wendel and Mark Brouillette and George Go and Kim, {Sang J.} and Lila Baaklini and Douglas Wetmore and Genewoo Hong and Rie Goto and Bridget Jivanelli and Eriphyli Argyra and Barrington, {Michael J.} and Alain Borgeat and {De Andres}, Jose and Elkassabany, {Nabil M.} and Gautier, {Philippe E.} and Peter Gerner and {Gonzalez Della Valle}, Alejandro and Enrique Goytizolo and Paul Kessler and Kopp, {Sandra L.} and Patricia Lavand'Homme and MacLean, {Catherine H.} and Mantilla, {Carlos B.} and Daniel MacIsaac and Alexander McLawhorn and Neal, {Joseph M.} and Michael Parks and Javad Parvizi and Lukas Pichler and Jashvant Poeran and Poultsides, {Lazaros A.} and Sites, {Brian D.} and Otto Stundner and Sun, {Eric C.} and Viscusi, {Eugene R.} and Votta-Velis, {Effrossyni G.} and Wu, {Christopher L.} and {Ya Deau}, {Jacques T.} and Sharrock, {Nigel E.}",
year = "2019",
month = "9",
doi = "10.1016/j.bja.2019.05.042",
language = "English (US)",
volume = "123",
pages = "269--287",
journal = "British Journal of Anaesthesia",
issn = "0007-0912",
publisher = "Oxford University Press",
number = "3",

}

TY - JOUR

T1 - Anaesthetic care of patients undergoing primary hip and knee arthroplasty

T2 - consensus recommendations from the International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) based on a systematic review and meta-analysis

AU - Memtsoudis, Stavros G.

AU - Cozowicz, Crispiana

AU - Bekeris, Janis

AU - Bekere, Dace

AU - Liu, Jiabin

AU - Soffin, Ellen M.

AU - Mariano, Edward R.

AU - Johnson, Rebecca L.

AU - Hargett, Mary J.

AU - Lee, Bradley H.

AU - Wendel, Pamela

AU - Brouillette, Mark

AU - Go, George

AU - Kim, Sang J.

AU - Baaklini, Lila

AU - Wetmore, Douglas

AU - Hong, Genewoo

AU - Goto, Rie

AU - Jivanelli, Bridget

AU - Argyra, Eriphyli

AU - Barrington, Michael J.

AU - Borgeat, Alain

AU - De Andres, Jose

AU - Elkassabany, Nabil M.

AU - Gautier, Philippe E.

AU - Gerner, Peter

AU - Gonzalez Della Valle, Alejandro

AU - Goytizolo, Enrique

AU - Kessler, Paul

AU - Kopp, Sandra L.

AU - Lavand'Homme, Patricia

AU - MacLean, Catherine H.

AU - Mantilla, Carlos B.

AU - MacIsaac, Daniel

AU - McLawhorn, Alexander

AU - Neal, Joseph M.

AU - Parks, Michael

AU - Parvizi, Javad

AU - Pichler, Lukas

AU - Poeran, Jashvant

AU - Poultsides, Lazaros A.

AU - Sites, Brian D.

AU - Stundner, Otto

AU - Sun, Eric C.

AU - Viscusi, Eugene R.

AU - Votta-Velis, Effrossyni G.

AU - Wu, Christopher L.

AU - Ya Deau, Jacques T.

AU - Sharrock, Nigel E.

PY - 2019/9

Y1 - 2019/9

N2 - Background: Evidence-based international expert consensus regarding anaesthetic practice in hip/knee arthroplasty surgery is needed for improved healthcare outcomes. Methods: The International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) systematic review, including randomised controlled and observational studies comparing neuraxial to general anaesthesia regarding major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, genitourinary, thromboembolic, neurological, infectious, and bleeding complications. Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, from 1946 to May 17, 2018 were queried. Meta-analysis and Grading of Recommendations Assessment, Development and Evaluation approach was utilised to assess evidence quality and to develop recommendations. Results: The analysis of 94 studies revealed that neuraxial anaesthesia was associated with lower odds or no difference in virtually all reported complications, except for urinary retention. Excerpt of complications for neuraxial vs general anaesthesia in hip/knee arthroplasty, respectively: mortality odds ratio (OR): 0.67, 95% confidence interval (CI): 0.57–0.80/OR: 0.83, 95% CI: 0.60–1.15; pulmonary OR: 0.65, 95% CI: 0.52–0.80/OR: 0.69, 95% CI: 0.58–0.81; acute renal failure OR: 0.69, 95% CI: 0.59–0.81/OR: 0.73, 95% CI: 0.65–0.82; deep venous thrombosis OR: 0.52, 95% CI: 0.42–0.65/OR: 0.77, 95% CI: 0.64–0.93; infections OR: 0.73, 95% CI: 0.67–0.79/OR: 0.80, 95% CI: 0.76–0.85; and blood transfusion OR: 0.85, 95% CI: 0.82–0.89/OR: 0.84, 95% CI: 0.82–0.87. Conclusions: Recommendation: primary neuraxial anaesthesia is preferred for knee arthroplasty, given several positive postoperative outcome benefits; evidence level: low, weak recommendation. Recommendation: neuraxial anaesthesia is recommended for hip arthroplasty given associated outcome benefits; evidence level: moderate-low, strong recommendation. Based on current evidence, the consensus group recommends neuraxial over general anaesthesia for hip/knee arthroplasty. Trial registry number: PROSPERO CRD42018099935.

AB - Background: Evidence-based international expert consensus regarding anaesthetic practice in hip/knee arthroplasty surgery is needed for improved healthcare outcomes. Methods: The International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) systematic review, including randomised controlled and observational studies comparing neuraxial to general anaesthesia regarding major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, genitourinary, thromboembolic, neurological, infectious, and bleeding complications. Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, from 1946 to May 17, 2018 were queried. Meta-analysis and Grading of Recommendations Assessment, Development and Evaluation approach was utilised to assess evidence quality and to develop recommendations. Results: The analysis of 94 studies revealed that neuraxial anaesthesia was associated with lower odds or no difference in virtually all reported complications, except for urinary retention. Excerpt of complications for neuraxial vs general anaesthesia in hip/knee arthroplasty, respectively: mortality odds ratio (OR): 0.67, 95% confidence interval (CI): 0.57–0.80/OR: 0.83, 95% CI: 0.60–1.15; pulmonary OR: 0.65, 95% CI: 0.52–0.80/OR: 0.69, 95% CI: 0.58–0.81; acute renal failure OR: 0.69, 95% CI: 0.59–0.81/OR: 0.73, 95% CI: 0.65–0.82; deep venous thrombosis OR: 0.52, 95% CI: 0.42–0.65/OR: 0.77, 95% CI: 0.64–0.93; infections OR: 0.73, 95% CI: 0.67–0.79/OR: 0.80, 95% CI: 0.76–0.85; and blood transfusion OR: 0.85, 95% CI: 0.82–0.89/OR: 0.84, 95% CI: 0.82–0.87. Conclusions: Recommendation: primary neuraxial anaesthesia is preferred for knee arthroplasty, given several positive postoperative outcome benefits; evidence level: low, weak recommendation. Recommendation: neuraxial anaesthesia is recommended for hip arthroplasty given associated outcome benefits; evidence level: moderate-low, strong recommendation. Based on current evidence, the consensus group recommends neuraxial over general anaesthesia for hip/knee arthroplasty. Trial registry number: PROSPERO CRD42018099935.

KW - anaesthesia

KW - anaesthesia

KW - anaesthesia

KW - arthroplasty

KW - arthroplasty

KW - assessment

KW - epidural

KW - general

KW - hip

KW - knee

KW - outcomes

KW - replacement

KW - replacement

KW - spinal

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DO - 10.1016/j.bja.2019.05.042

M3 - Review article

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JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

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