Correspondence  |   June 2019
Hospital-level Neuraxial Use in Orthopedics: Comment
Author Notes
  • Larner College of Medicine, University of Vermont, Burlington, Vermont (J.A.M). jacob.martin@uvmhealth.org
  • (Accepted for publication March 6, 2019.)
    (Accepted for publication March 6, 2019.)×
Article Information
Correspondence
Correspondence   |   June 2019
Hospital-level Neuraxial Use in Orthopedics: Comment
Anesthesiology 6 2019, Vol.130, 1087-1088. doi:10.1097/ALN.0000000000002719
Anesthesiology 6 2019, Vol.130, 1087-1088. doi:10.1097/ALN.0000000000002719
In a large retrospective study, Memtsoudis et al.1  demonstrated that patients receiving neuraxial anesthesia for primary hip and knee arthroplasties had lower costs of hospitalization. Presumably, neuraxial anesthesia may provide a clinical benefit (e.g., decreased incidence of deep vein thrombosis, reduced cardiopulmonary complications, reduced opiate consumption, and lower incidence of postoperative delirium) when compared to general anesthesia for total joint replacements. Curiously, none of the clinical outcomes assessed in this study reached a level of significance, leaving three possible explanations for their results: a type II error, an accounting error, or some other downstream clinical benefit not measured in this trial. We believe that the first explanation is unlikely given the size of the study population and the third will require further study. However, the second explanation deserves a closer examination.