Background: Under the assumption that postoperative nausea and vomiting (PONV) may occur after total hip\narthroplasty (THA) regardless of the anesthetic technique used, it is not clear whether general (GA) or spinal (SA)\nanesthesia has higher causal effect on this occurrence. Conflicting results have been reported.\nMethods: In this observational study, we selected all elective THA interventions performed in adults between 1999\nand 2008 in a Swiss orthopedic clinic under general or spinal anesthesia. To assess the effect of anesthesia type on\nthe occurrence of PONV, we used the propensity score and matching methods, which allowed us to emulate the\ndesign and results of an RCT.\nResults: Among 3922 procedures, 1984 (51 %) patients underwent GA, of which 4.1 % experienced PONV, and\n1938 underwent SA, of which 3.5 % experienced PONV. We found that the average treatment effect on the treated,\ni.e. the effect of anesthesia type for a sample of individuals that actually received spinal anesthesia compared to\nindividuals who received GA, was ATET = 2.00 % [95 % CI, 0.78ââ?¬â??3.19 %], which translated into an OR = 1.97 [95 % CI\n1.35; 2.87].\nConclusion: This suggests that the type of anesthesia is not neutral regarding PONV, general anesthesia being\nmore strongly associated with PONV than spinal anesthesia in orthopedic surgery.
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