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Comparison of the incidence of venous thromboembolism between epidural and general anesthesia for total knee arthroplasty: a retrospective study
Anesth Pain Med 2018;13(2):214-21
Published online April 30, 2018
© 2018 The Korean Society of Anesthesiologists.

Jeong Eun Lee1 , Dong-ho Jung1, Jae-Min Yang1, Won Kee Lee2, Younghoon Jeon1,3, and Si-Oh Kim1
1Department of Anesthesiology and Pain Medicine, 2Medical Research Collabration Center in KNUH, School of Medicine, Kyungpook National University, 3School of Dentistry, Kyungpook National University, Daegu, Korea
Correspondence to: Jeong Eun Lee, M.D.
Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Korea
Tel: 82-53-420-5864
Fax: 82-53-426-2760
Received May 25, 2017; Revised September 21, 2017; Accepted October 1, 2017.
cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
Key Words : Epidural anesthesia, General anesthesia, Knee arthroplasty, Pulmonary embolism, Venous thrombosis.

April 2018, 13 (2)
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