{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:26:13Z","timestamp":1790144773757,"version":"4.0.1"},"reference-count":35,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Spinal and general anaesthesia are the most common anaesthetic methods for hip and knee arthroplasties. Differences in their effects on short\u2010 and long\u2010term postoperative outcomes, including mortality morbidity, and adverse events, remain uncertain. Identifying the anesthetic method that provides the best recovery could help optimise patient care. Previous reviews have reported conflicting results and have methodological limitations, highlighting the need for an updated systematic review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This protocol describes a Preferred Reporting Items for Systematic Review and Meta\u2010analysis (PRISMA) compliant systematic review and meta\u2010analysis of randomised clinical trials, incorporating Trial sequential analysis. The review aims to evaluate the beneficial and harmful effects of spinal versus general anaesthesia in adult patients undergoing hip or knee arthroplasty. To identify relevant trials, we will search major medical databases (e.g., MEDLINE, EMBASE, CENTRAL) and clinical trial registries and include all trials directly comparing spinal versus general anaesthesia. Two review authors will independently screen the literature, extract data and conduct risk of bias assessment (Cochrane Risk of Bias tool\u2014version 2 (RoB\u20102)). The primary outcome will be the proportion of participants with one or more serious adverse events. Secondary outcomes will be pain, postoperative opioid consumption, time to first mobilisation, hospital length of stay, non\u2010serious adverse events, and quality of recovery. The certainty of evidence will be assessed by Grading of Recommendations, Assessment, Development and Evaluations (GRADE) and presented in a \u2018Summary of Findings\u2019 table.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>To guide clinicians in choosing between spinal and general anaesthesia for hip and knee arthroplasties, a systematic review of the existing evidence is needed. This review will support clinicians and patients in weighing the benefits against the harms of the two anaesthetic methods and in making evidence\u2010based, informed decisions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aas.70231","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T01:05:27Z","timestamp":1774919127000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Adverse Effects Associated With Spinal Versus General Anaesthesia for Hip and Knee Arthroplasties: Protocol for a Systematic Review"],"prefix":"10.1111","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1577-5437","authenticated-orcid":false,"given":"Anne Sofie Nautrup","family":"Therkelsen","sequence":"first","affiliation":[{"name":"Centre for Anaesthesiological Research, Department of Anaesthesiology Zealand University Hospital  Koege Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans Bredgaard","family":"Christensen","sequence":"additional","affiliation":[{"name":"Centre for Anaesthesiological Research, Department of Anaesthesiology Zealand University Hospital  Koege Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne\u2010Lene","family":"Kj\u00e6ldgaard","sequence":"additional","affiliation":[{"name":"Centre for Anaesthesiological Research, Department of Anaesthesiology Zealand University Hospital  Koege Denmark"},{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6817-7510","authenticated-orcid":false,"given":"Camilla","family":"Godthaab","sequence":"additional","affiliation":[{"name":"Centre for Anaesthesiological Research, Department of Anaesthesiology Zealand University Hospital  Koege Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina Dam Bjerregaard","family":"Sillassen","sequence":"additional","affiliation":[{"name":"Copenhagen Trial Unit Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet  Copenhagen Denmark"},{"name":"Department of Regional Health Research, The Faculty of Health Sciences University of Southern Denmark  Odense Denmark"},{"name":"Department of Cardiology Naestved, Slagelse, and Ringsted Hospital  Slagelse Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Troels Haxholdt","family":"Lunn","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen Denmark"},{"name":"Department of Anaesthesia and Intensive Care Copenhagen University Hospital, Bispebjerg and Frederiksberg  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8008-6614","authenticated-orcid":false,"given":"Daniel","family":"H\u00e4gi\u2010Pedersen","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen Denmark"},{"name":"Department of Anaesthesiology Naestved, Slagelse, and Ringsted Hospital  Naestved Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0625-5691","authenticated-orcid":false,"given":"Claus","family":"Varnum","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Lillebaelt Hospital  Veile Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Lindberg\u2010Larsen","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Traumatology Odense University Hospital  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kasper H\u00f8jgaard","family":"Thybo","sequence":"additional","affiliation":[{"name":"Centre for Anaesthesiological Research, Department of Anaesthesiology Zealand University Hospital  Koege Denmark"},{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janus Christian","family":"Jakobsen","sequence":"additional","affiliation":[{"name":"Copenhagen Trial Unit Centre for Clinical Intervention Research, Copenhagen University Hospital, Rigshospitalet  Copenhagen Denmark"},{"name":"Department of Regional Health Research, The Faculty of Health Sciences University of Southern Denmark  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4544-0619","authenticated-orcid":false,"given":"Ole","family":"Mathiesen","sequence":"additional","affiliation":[{"name":"Centre for Anaesthesiological Research, Department of Anaesthesiology Zealand University Hospital  Koege Denmark"},{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.170990"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.artd.2023.101152"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000437"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2012.03.008"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/17453674.2019.1683790"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13103017"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2019.05.042"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cps.2013.07.001"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000014925"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aev455"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.23736\/S0375\u20109393.25.19043\u20103"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/2046-4053-4-1"},{"key":"e_1_2_9_14_1","unstructured":"\u201cICH E6 (R3) Guideline for Good Clinical Practice (GCP) \u2013 Step 5 \u201dhttps:\/\/www.ema.europa.eu\/en\/documents\/scientific\u2010guideline\/ich\u2010e6\u2010r3\u2010guideline\u2010good\u2010clinical\u2010practice\u2010gcp\u2010step\u20105_en.pdf."},{"key":"e_1_2_9_15_1","unstructured":"\u201cCovidence Systematic Review Software Veritas Health Innovation Melbourne Australia \u201dwww.covidence.org."},{"key":"e_1_2_9_16_1","unstructured":"R Core Team \u201cR: A Language and Environment for Statistical Computing \u201dhttps:\/\/www.R\u2010project.org\/."},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-135-11-200112040-00010"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.MR000033.pub3"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)01085-X"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557"},{"key":"e_1_2_9_22_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 6.5","author":"Deeks J. J.","year":"2024"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1515\/ijb-2022-0070"},{"key":"e_1_2_9_24_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 6.5","author":"Page M. J.","year":"2024"},{"key":"e_1_2_9_25_1","doi-asserted-by":"crossref","unstructured":"\u201cA Modified Test for Small\u2010Study Effects in Meta\u2010Analyses of Controlled Trials With Binary Endpoints \u201dhttps:\/\/doi.org\/10.1002\/sim.2380.","DOI":"10.1002\/sim.2380"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.2971"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d4002"},{"key":"e_1_2_9_28_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 6.5","author":"Higgins J. P.","year":"2024"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-14-120"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-017-0315-7"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.10.007"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyn188"},{"key":"e_1_2_9_33_1","unstructured":"K.Thorlund J.Engstr\u00f8m J.Wetterslev J.Brok G.Imberger andC.Gluud \u201cUser Manual for Trial Sequential Analysis (TSA) \u201dhttp:\/\/ctu.dk\/wp\u2010content\/uploads\/2021\/03\/2017\u201010\u201010\u2010TSA\u2010Manual\u2010ENG_ER.pdf."},{"key":"e_1_2_9_34_1","article-title":"False\u2010Positive Findings in Cochrane Meta\u2010Analyses With and Without Application of Trial Sequential Analysis: An Empirical Review","volume":"6","author":"Imberger G.","year":"2016","journal-title":"British Medical Journal Open"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.04.026"},{"key":"e_1_2_9_36_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 6.5","author":"Sch\u00fcnemann H. J.","year":"2024"}],"container-title":["Acta Anaesthesiologica Scandinavica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aas.70231","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/aas.70231","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aas.70231","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T08:29:32Z","timestamp":1787905772000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/aas.70231"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,30]]},"references-count":35,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1111\/aas.70231"],"URL":"https:\/\/doi.org\/10.1111\/aas.70231","archive":["Portico"],"relation":{},"ISSN":["0001-5172","1399-6576"],"issn-type":[{"value":"0001-5172","type":"print"},{"value":"1399-6576","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,30]]},"assertion":[{"value":"2026-02-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70231"}}