The impact of neuraxial versus general anesthesia on the incidence of postoperative surgical site infections following knee or hip Arthroplasty a meta-analysis

Background: Recent studies have yielded conflicting results on the association between anesthesia technique and incidence of postoperative surgical site infections (SSIs) after knee arthroplasty (KA) and hip arthroplasty (HA). Our group conducted a meta-analysis of all available studies to clarify this potential association. Methods: Our group searched MEDLINE, EMBASE, and Google Scholar for all relevant studies (1990-2015) reporting on the association between anesthetic technique and SSI after KA or HA. Meta-analysis was performed to estimate both the pooled unadjusted odds ratio (OR) and adjusted OR (aOR) using a random-effects model. Subgroup analyses and metaregression were conducted to explore potential sources of heterogeneity and bias. Results: Of the initial 435 records, 13 studies (n = 362,029) met the inclusion criteria. The use of neuraxial anesthesia was associated with a significant reduction in incidence of postoperative SSI as compared with general anesthesia for all arthroplasties based on unadjusted (OR, 0.77; 95% confidence interval [CI], 0.70-0.86; P < 0.001) and adjusted (aOR = 0.84; 95%CI, 0.76-0.92; P < 0.001) data. Subgroup analyses showed similar reductions in incidence of postoperative SSI for KA (OR = 0.75; 95% CI, 0.68-0.84; P < 0.001; aOR = 0.85; 95% CI, 0.79-0.92; P < 0.001) and HA (OR = 0.79; 95% CI, 0.65 to 0.95; P = 0.02; aOR = 0.84; 95% CI, 0.71-1.00; P = 0.057). Conclusions: Synthesis of the existing evidence supports the overall beneficial effects of neuraxial anesthesia in decreasing the development of SSI after joint arthroplasty (KA and HA). Given the limitations associated with interpretation of data from large observational trials, further investigation using prospective randomized trial design iswarranted in this promising area.