Functional impairment in patients undergoing major orthopaedic surgery under general anaesthesia with or without regional anaesthesia: a target trial emulation using a national hospital claims database

doi:10.1016/j.bja.2026.06.008

Perioperative medicine & outcomes

Functional impairment in patients undergoing major orthopaedic surgery under general anaesthesia with or without regional anaesthesia: a target trial emulation using a national hospital claims database

Br J AnaesthPublished 17 Jul 2026Target trial emulation using a national hospital claims database

Main findingResultMean difference 0.73 95% CI 0.57–0.88

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Authors' conclusion

Combined general and regional anaesthesia was associated clinically with modest improvements in discharge-anchored functional change, postoperative stay and in-hospital mortality.

Study context

Population: Adults undergoing major orthopaedic surgery, Japanese Diagnosis Procedure Combination database, April 1, 2016-December 31, 2023
Participants: 244,212 vs 435,462

Exposure: GA+RA vs GA alone
GA+RAn = 244,212
GA alonen = 435,462reference
Outcome: Discharge-anchored functional change (difference in Barthel Index scores between admission and discharge)
Follow-up: Discharge

Methodological detailsstabilised inverse probability of treatment weighting, multiple imputation

Stabilised inverse probability of treatment weighting
Multiple imputation

Main finding

As reported in the abstract

Mean difference

0.73

95% CI 0.57–0.88

P < 0.001

GA+RA vs GA alone

mean difference 0.73 (95% CI 0.57–0.88); P < 0.001

Observational data: associations, not effects.

Secondary outcomes

Outcome	← Lower with GA+RA ←→ Higher with GA+RA →	Difference (days) (95% CI)	P value
Postoperative LOS	−2−101	−1.40 (−1.45 to −1.35)	P < 0.001
	−2−101Difference, days (linear scale)

Outcome	← Lower risk with GA+RA ←→ Higher risk with GA+RA →	HR (95% CI)	P value
In-hospital mortality	0.512	0.85 (0.76–0.96)	P = 0.006
	0.512Hazard ratio (log scale)

Sensitivity analyses

Directionally consistent findings

Original publication

Functional impairment in patients undergoing major orthopaedic surgery under general anaesthesia with or without regional anaesthesia: a target trial emulation using a national hospital claims database. Br J Anaesth. Published 17 July 2026. doi:10.1016/j.bja.2026.06.008

Read the original article ↗

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