Evaluation of the use of spinal anesthesia administered prior to proceeding to the operating room in patients undergoing total joint arthroplasty

Abstract Background : Previous studies have demonstrated improvements in efficiency when specific procedures are performed in a designated preoperative area prior to proceeding to the operating room. In this study the authors sought to evaluate if spinal anesthesia could be safely and efficiently administered prior to proceeding to the operating room when compared to general anesthesia and spinal anesthesia administered in the operating room. Methods : The authors reviewed the electronic health record at a single institution between the years 2012 to 2018. Total joint arthroplasties by a single surgeon were identified and the specific time frames of interest were measured and compared between patients who received a spinal anesthetic in the preoperative area, patients who received a general anesthetic, and patients who received a spinal anesthetic in the operating room. These time frames of interest included: anesthesia induction time, operating room recovery time, post anesthesia recovery unit time, and operating room turnover time. The electronic medical record was also reviewed for spinal-related adverse events. Categorical variables were compared using the Fisher exact test and continuous variables were compared using equal-variance t-test and one-way ANOVA. Results : The study cohort consisted of 246 patients (142 total hip arthroplasty and 104 total knee arthroplasty); 40.2% (99) of patients received a general anesthetic (GA), 52% (128) of patients received a preoperative spinal anesthetic (PSA), and 7.7% (19) of patients received an intraoperative spinal anesthetic (ISA). Preoperative spinal anesthetics demonstrated a shorter anesthesia induction time, shorter operating room recovery times, shorter PACU recovery times, and longer operating room turnover times when compared to general anesthesia and intraoperative spinals. There were no spinal-related adverse events. Conclusion :The results of this retrospective cohort study demonstrate that administration of spinal anesthesia in the preoperative area is safe as compared with intra-operative spinal administration. Pre-operative spinal for total joint arthroplasty reduces time spent in the operating room and PACU when compared with general anesthesia and intraoperative spinal but it does not substantially affect overall perioperative efficiency.