Anesthesia practice among joint arthroplasty patients with a previous lumbar spine surgery

Alex Illescas, Haoyan Zhong, Crispiana Cozowicz, Jashvant Poeran, Stavros G. Memtsoudis, Jiabin Liu

Research output: Contribution to journalArticlepeer-review


Study objective: To analyze the use of neuraxial techniques in total hip or knee arthroplasty patients who previously underwent lumbar spine surgeries. Design: Retrospective analysis of a national database. Setting: U.S. hospitals. Patients: Patients undergoing a total hip or knee arthroplasty, stratified by those with a previous lumbar fusion or decompression procedure. Measurements: Our primary outcome was the use of neuraxial anesthesia; secondary outcomes included combined complications, cardio-pulmonary complications, and prolonged length of stay. Patients with and without a history of a lumbar procedure were compared using mixed-effects regression. Main results: Among 758,857 THAs 8961 had a history of lumbar fusion and 8599 of decompression. Among 1,387,335 TKAs 15,827 had a history of lumbar fusion and 13,652 of decompression. History of a lumbar fusion was associated with lower odds of neuraxial anesthesia use in THA (OR: 0.74 CI: 0.70–0.79, p ≤0.0001) and TKA (OR: 0.80 CI: 0.77–0.84, p ≤0.0001). Conclusions: Previous lumbar fusion -but not decompression- surgery is associated with lower neuraxial anesthesia in THA/TKA patients, despite its use being universally associated with decreased length of stay. More research is needed to address the importance of neuraxial techniques in patients with prior spine surgery.

Original languageEnglish
Article number111222
JournalJournal of Clinical Anesthesia
StatePublished - Nov 2023


  • Anesthesia
  • Lumbar surgery
  • Total hip arthroplasty
  • Total knee arthroplasty


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