Table 1.
Grading of Recommendations Assessment, Development and Evaluation (GRADE) summary of findings for total hip arthroplasty (THA). CI, confidence interval; GA, general anaesthesia; MI, myocardial infarction; NA, neuraxial anaesthesia; OR, odds ratio. GRADE Working Group grades of evidence: high certainty (we are very confident that the true effect lies close to that of the estimate of the effect), moderate certainty (we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different), low certainty (our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect), and very low certainty (we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect). ∗The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). †Publication bias: funnel plot not symmetric. ‡Heterogeneity: widely differing estimates of effect.
| Summary of findings | ||||||
|---|---|---|---|---|---|---|
| NA compared with GA for THA | ||||||
| Patient or population: THA Setting: perioperative care Intervention: NA Comparison: GA | ||||||
| Outcomes/complications | Anticipated absolute effects∗ (95% CI) |
Relative effect (95% CI) | No. of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with GA | Risk with NA | |||||
| Mortality | 2 per 1000 | 1 per 1000 (1–2) | OR: 0.67 (0.57–0.80) | (3 RCTs, 4 observational studies) | ⊕⊕◯◯ Low |
|
| Cardiac including MI | 57 per 1000 | 53 per 1000 (50–58) | OR: 0.94 (0.88–1.02) | (3 RCTs, 3 observational studies) | ⊕⊕◯◯ Low |
|
| Cardiac excluding MI | 48 per 1000 | 47 per 1000 (43–50) | OR: 0.96 (0.88–1.03) | (2 RCTs, 3 observational studies) | ⊕◯◯◯ Very low† |
|
| MI | 3 per 1000 | 3 per 1000 (2–4) | OR: 0.94 (0.71–1.24) | (2 RCTs, 2 observational studies) | ⊕⊕◯◯ Low |
|
| Pulmonary | 7 per 1000 | 4 per 1000 (3–5) | OR: 0.65 (0.52–0.80) | (3 observational studies) | ⊕⊕⊕◯ Moderate |
|
| Pneumonia | 10 per 1000 | 7 per 1000 (5–8) | OR: 0.69 (0.56–0.84) | (2 RCTs, 2 observational studies) | ⊕⊕⊕◯ Moderate |
|
| Gastrointestinal | 10 per 1000 | 8 per 1000 (7–10) | OR: 0.83 (0.67–1.02) | 109 732 (1 observational study) | ⊕⊕◯◯ Low |
|
| Acute renal failure | 15 per 1000 | 10 per 1000 (9–12) | OR: 0.69 (0.59–0.81) | (1 RCT, 5 observational studies) | ⊕⊕◯◯ Low‡ |
|
| Urinary retention | 111 per 1000 | 277 per 1000 (199–370) | OR: 3.05 (1.98–4.69) | (3 RCTs, 3 observational studies) | ⊕⊕⊕◯ Moderate |
|
| Urinary tract infection | 15 per 1000 | 13 per 1000 (10–15) | OR: 0.86 (0.70–1.06) | (2 observational studies) | ⊕⊕◯◯ Low |
|
| DVT | 15 per 1000 | 8 per 1000 (6–10) | OR: 0.52 (0.42–0.65) | (5 RCTs, 8 observational studies) | ⊕⊕⊕◯ Moderate |
|
| Pulmonary embolism (PE) | 3 per 1000 | 2 per 1000 (2–2) | OR: 0.63 (0.50–0.81) | (7 RCTs, 6 observational studies) | ⊕⊕◯◯ Low |
|
| Thromboembolism (DVT+PE) | 5 per 1000 | 3 per 1000 (3–4) | OR: 0.61 (0.53–0.71) | (15 RCTs, 16 observational studies) | ⊕⊕⊕◯ Moderate |
|
| CNS | 2 per 1000 | 1 per 1000 (0–1) | OR: 0.39 (0.23–0.65) | (3 observational studies) | ⊕⊕⊕◯ Moderate |
|
| Stroke | 2 per 1000 | 1 per 1000 (0–1) | OR: 0.37 (0.22–0.64) | (2 observational studies) | ⊕⊕⊕◯ Moderate |
|
| All infections (including pneumonia and sepsis) | 25 per 1000 | 19 per 1000 (17–20) | OR: 0.73 (0.67–0.79) | (2 RCTs, 7 observational studies) | ⊕⊕◯◯ Low |
|
| Wound superficial infection | 8 per 1000 | 9 per 1000 (7–12) | OR: 1.21 (0.93–1.56) | (1 RCT, 2 observational studies) | ⊕⊕◯◯ Low |
|
| Wound deep infection | 7 per 1000 | 6 per 1000 (5–7) | OR: 0.86 (0.70–1.06) | (3 observational studies) | ⊕⊕◯◯ Low |
|
| Blood transfusion | 224 per 1000 | 197 per 1000 (192–205) | OR: 0.85 (0.82–0.89) | (8 RCTs, 9 observational studies) | ⊕◯◯◯ Very low† |
|
| Critical care admission | 2 per 1000 | 1 per 1000 (1–2) | OR: 0.80 (0.49–1.32) | (2 observational studies) | ⊕⊕◯◯ Low |
|
| Readmission | 38 per 1000 | 34 per 1000 (30–39) | OR: 0.91 (0.80–1.04) | 28 857 (1 observational study) | ⊕⊕◯◯ Low |
|
| Nerve injury | 2 per 1000 | 2 per 1000 (1–3) | OR: 0.81 (0.56–1.18) | (1 RCT, 4 observational studies) | ⊕⊕◯◯ Low |
|
| Falls | 16 per 1000 | 13 per 1000 (12–15) | OR: 0.81 (0.72–0.92) | 166 871 (1 observational study) | ⊕⊕◯◯ Low |
|
| Blood loss (ml) | The mean blood loss was 0. | The mean blood loss in the intervention group was 146.12 lower (173.73 lower to 118.51 lower). | — | 1546 (12 RCTs, 4 observational studies) | ⊕⊕⊕◯ Moderate‡ |
|
| Length of stay (days) | The mean length of hospital stay (LOS) was 0. | The mean LOS in the intervention group was 0.16 lower (0.22 lower to 0.1 lower). | — | (1 RCT, 1 observational study) | ⊕⊕◯◯ Low |
|
| Blood transfusion (ml) | The mean blood transfusion was 0. | The mean blood transfusion in the intervention group was 187.83 lower (272.29 lower to 103.38 lower). | — | (2 RCTs, 3 observational studies) | ⊕⊕◯◯ Low |
|