Comparison of the incidence of venous thromboembolism between epidural and general anesthesia for total knee arthroplasty: a retrospective study

ABSTRACT

BACKGROUND: Substantial variation exists in the reported rates of postoperative venous thromboembolism (VTE) following total knee arthroplasty (TKA) in the Asian population. This retrospective study aimed to compare the early postoperative VTE incidence between patients managed with epidural anesthesia and those managed by general anesthesia at the time of TKA. METHODS: We reviewed 589 cases of unilateral primary TKA performed between January 2011 and June 2014. We selected epidural versus general anesthesia groups as the main anesthetic choices, with postoperative patient-controlled analgesia. All the patients underwent deep vein thrombosis (DVT) computed tomography angiography on postoperative day 7. The incidence of DVT and pulmonary thromboembolism (PTE) was evaluated and compared between epidural and general anesthesia. RESULTS: The overall incidence of VTE was 8.0% in the two groups together. The incidence did not differ between the groups. The odds ratio in the generalized estimation equations analysis showed a higher incidence of DVT and PTE in the epidural group; however, this result was not statistically significant. Although, the odds ratio for age showed that the risk of developing DVT and PTE increased 1.12 times per year. CONCLUSIONS: Total VTE incidence was not significantly different between patients who underwent general anesthesia and those who underwent epidural anesthesia for TKA. A prospective multicenter study is required to evaluate the nature of the Korean VTE status in major orthopedic surgeries, and to prepare guidelines and protocols for medical prophylaxis for DVT and PTE in Korea.