Capitalizing the amount of data does make it more clinically relevant, I agree!
Seriously like, what 'ga' did these people have? Did the have a good ga, a bad ga? A white stuff ga? A little syringe, big syringe ga? You know those small insignificant details that would change a study utterly that aren't reported in your trial?
I repeat 30 percent of your trial had to be excluded because they couldn't ascertain even what type of anesthetic was performed. That is 3rd world standard of care/reporting. So for me, I'll ignore that
You're ignoring one of the most important trials in the subject because of the 500k+ records they looked at, they kicked out 30% because they couldn't figure out what kind of anesthesia they received? Do you even know how to read a study???
Here's a more comprehensive look at the topic:
Perioperative Comparative Effectiveness of Anesthetic Technique in Orthopedic Patients
Read the section on anesthesia techniques:
"Recent studies, utilizing large database sources that allowed for larger sample sizes and an evaluation of real world practice, have demonstrated more positive results related to the use of RA techniques for TKA. In a 2013 retrospective study,
236,030 patients received spinal anesthesia and 8,022 patients received GA. The patients receiving spinal anesthesia had a lower rate of wound infection, blood transfusions, and overall complications. The length of surgery and hospital LOS were both decreased in the spinal anesthesia population. These effects were more pronounced among patients with numerous comorbidities.
23 In a 2012 study comparing GA and NA for bilateral TKA, improved outcomes were identified in the neuraxial group.
24 Of the 15,687 patients, 80.1% had GA, 13.1 had a combination of GA and NA, and 6.8 had only NA. Patients in the NA-only group required fewer blood transfusions and exhibited lower, but nonsignificant, rates of in-hospital mortality, 30-day mortality, and overall complications.
24 In 2013, Memtsoudis et al
25,
26 published two additional studies in support of NA. In both studies, the patient population was split into three groups: NA, GA, and combined NA and GA. The first study utilized a population of 382,236 patient entries with TKA/THA and identified that patients receiving NA had significantly lower 30-day mortality rates compared to GA (0.10% vs 0.18%, respectively;
P<0.001) and a lower incidence of prolonged LOS, increased cost, and in-hospital complications.
2 After multivariate analysis, GA was found to be associated with increased 30-day mortality (OR 1.83, 95% CI 1.08–3.1,
P=0.02), higher risk of pulmonary compromise (OR 1.83, 95% CI, 1.43–2.35,
P<0.0001), pneumonia (OR 1.27, 95% CI 1.05–1.53,
P=0.0083), all infections (OR 1.38, 95% CI 1.26–1.52,
P<0.0001), and acute renal failure (OR 1.44, 95% CI 1.24–1.67,
P<0.0001). Transfusion requirements were lowest in the NA-only group. The incidence of prolonged LOS was greatest in the GA-only group.
25 The second study by Memtsoudis et al
26 demonstrated benefits for NA in 30,024 sleep apnea patients undergoing TKA. Of these patients, 74% received GA, 15% received NA and GA, and 11% received NA only with no GA.
26 Rates of pulmonary, gastrointestinal, infectious, and renal complications were all lower in the NA-only patients. Transfusions, mechanical ventilation, and critical care services were lower in patients receiving NA and NA/GA compared to those receiving only GA. The GA-only patients also had the longest LOS. The cost of all three groups did not differ substantially averaging ~$15,510 per surgery with a standard deviation of only $225.
26 The improved outcome assessment from these large database sources has been left vulnerable by the fact that these studies were retrospective and utilized administrative data sources that may be susceptible to coding errors and data quality concerns."
