@article{3105708,
    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",
    author = "Memtsoudis, S.G. and Cozowicz, C. and Bekeris, J. and Bekere, D. and Liu, J. and Soffin, E.M. and Mariano, E.R. and Johnson, R.L. and Hargett, M.J. and Lee, B.H. and Wendel, P. and Brouillette, M. and Go, G. and Kim, S.J. and Baaklini, L. and Wetmore, D. and Hong, G. and Goto, R. and Jivanelli, B. and Argyra, E. and Barrington, M.J. and Borgeat, A. and De Andres, J. and Elkassabany, N.M. and Gautier, P.E. and Gerner, P. and Gonzalez Della Valle, A. and Goytizolo, E. and Kessler, P. and Kopp, S.L. and Lavand'Homme, P. and MacLean, C.H. and Mantilla, C.B. and MacIsaac, D. and McLawhorn, A. and Neal, J.M. and Parks, M. and Parvizi, J. and Pichler, L. and Poeran, J. and Poultsides, L.A. and Sites, B.D. and Stundner, O. and Sun, E.C. and Viscusi, E.R. and Votta-Velis, E.G. and Wu, C.L. and Ya Deau, J.T. and Sharrock, N.E.",
    journal = "BRITISH JOURNAL OF ANAESTHESIA",
    year = "2019",
    volume = "123",
    number = "3",
    pages = "269-287",
    publisher = "Elsevier Ireland Ltd",
    issn = "0007-0912",
    doi = "10.1016/j.bja.2019.05.042",
    keywords = "acute kidney failure;  anesthesia;  blood transfusion;  cerebrovascular accident;  clinical outcome;  consensus;  deep vein thrombosis;  evidence based practice;  gastrointestinal symptom;  general anesthesia;  heart infarction;  human;  lung complication;  meta analysis;  mortality;  nerve injury;  neuraxial anesthesia;  pneumonia;  postoperative care;  postoperative complication;  postoperative hemorrhage;  postoperative infection;  priority journal;  pulmonary embolism response team;  randomized controlled trial (topic);  Review;  surgical infection;  surgical mortality;  systematic review;  total hip replacement;  total knee arthroplasty;  urinary tract infection;  urine retention;  consensus development;  epidural anesthesia;  evidence based medicine;  hip replacement;  knee replacement;  procedures;  spinal anesthesia;  treatment outcome, Anesthesia, Epidural;  Anesthesia, General;  Anesthesia, Spinal;  Arthroplasty, Replacement, Hip;  Arthroplasty, Replacement, Knee;  Evidence-Based Medicine;  Humans;  Postoperative Complications;  Randomized Controlled Trials as Topic;  Treatment Outcome",
    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. © 2019 British Journal of Anaesthesia"
}