Epidural versus general anesthesia in elderly lower limb orthopedic surgery: a retrospective study on pulmonary complications and costs

Abstract

Objective: This study aims to assess the impact of general anesthesia versus epidural anesthesia on clinical outcomes in elderly orthopedic patients undergoing lower limb surgeries. Methods: This retrospective study included patients aged ≥75 years who underwent hip, knee, and femoral shaft surgeries at the Third Affiliated Hospital of Sun Yat-sen University were included in the study. Patients were divided into two groups based on the anesthetic technique: general anesthesia group and epidural anesthesia group. Patient demographic information and intraoperative clinical parameters were collected. The primary outcome was the incidence of postoperative pulmonary complications (including pulmonary infection). Secondary outcomes included intensive care unit (ICU) admission rates, hospitalization costs, postoperative length of stay, and other complications (e.g., cardiac, cerebrovascular). Results: Patients in the epidural anesthesia group had a significantly shorter stay in the post-anesthesia care unit (PACU) and a lower ICU admission rate (1.15% vs. 15.45%). The incidence of postoperative pulmonary complications, the primary outcome of interest, was significantly lower in the epidural anesthesia group (7.3% vs. 16.4%), with pulmonary infection also showing a marked reduction (5.8% vs. 14.5%). Total hospitalization costs were lower in the epidural group (34,000 vs. 40,000 RMB). While general anesthesia showed a trend toward increased odds of pulmonary infection (OR=2.208, P=0.066), this association was of borderline statistical significance. No significant differences were observed between the two groups in postoperative pain management requirements or cardiovascular-related complications. Conclusion: For orthopedic patients aged 75 years and older, epidural anesthesia provides significant advantages in terms of postoperative recovery, particularly in reducing postoperative pulmonary infections and complications. General anesthesia was associated with a higher risk of these adverse outcomes. Therefore, epidural anesthesia was associated with more favorable postoperative recovery profiles, including lower rates of pulmonary complications and reduced costs, compared to general anesthesia in this high-risk elderly population.