General versus spinal anesthesia and early functional and discharge outcomes after geriatric total joint arthroplasty: an NSQIP database retrospective cohort study

BACKGROUND: Older adults undergoing total joint arthroplasty (TJA) are particularly vulnerable to postoperative functional decline, yet the impact of anesthetic technique on recovery remains uncertain. This study examined whether spinal anesthesia (SA), compared with general anesthesia (GA), is associated with early functional decline and non-home discharge in geriatric patients undergoing elective total hip arthroplasty (THA) or total knee arthroplasty (TKA). METHODS: We performed a retrospective cohort study using the 2021-2023 American College of Surgeons National Surgical Quality Improvement Program database. Patients aged ≥75 years undergoing THA or TKA were included. The primary outcome was functional status decline, defined as any reduction in activities of daily living independence from preoperative status to hospital discharge. The secondary outcome was discharge disposition, categorized as home versus non-home. Multivariable logistic regression was used to estimate adjusted ORs (aORs) for associations between anesthetic type and outcomes. RESULTS: The cohort included 62 338 cases (GA: 30 296; SA: 32 042). GA was associated with higher rates of functional decline (38.5% vs 30.2%; p