{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T10:46:10Z","timestamp":1782384370645,"version":"3.54.5"},"reference-count":43,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Evidence on spinal versus general anesthesia in unilateral total knee arthroplasty (TKA) may not extend to one-week-staged bilateral surgery, where older patients receive two anesthetics in a short interval and intra-operative spinal-to-general conversion is common but rarely reported transparently. We compared peri-operative acute kidney injury (AKI) and transfusion between strategies in this setting. Methods: We retrospectively analyzed 207 patients (414 surgeries) undergoing one-week-staged bilateral primary TKA at one center. Co-primary endpoints were creatinine-based AKI (patient level) and packed-red-blood-cell transfusion (surgery level). Because 42 general-anesthesia-classified surgeries had an attempted spinal injection, the primary analysis used the initial anesthetic plan (an intention-to-treat analogue), reclassifying these as spinal, with as-treated classification as a sensitivity analysis; AKI was modeled at the patient level (any general anesthesia versus spinal\u2013spinal) and transfusion per surgery. Results: Median age was 75 years and 82.6% were female; AKI affected 74 of 207 patients (35.7%) and transfusion 185 of 414 surgeries (44.7%). The adjusted any-general-anesthesia versus spinal\u2013spinal estimate was not statistically significant and opposite the spinal-protective hypothesis (adjusted odds ratio 0.49, 95% confidence interval 0.23\u20131.01, p = 0.054), and no pre-specified sensitivity scenario survived Benjamini\u2013Hochberg correction. Transfusion did not differ between strategies; among secondary endpoints, length of stay, hemoglobin drop, peak C-reactive protein, and intra-operative hypotension likewise showed no significant difference after multiplicity correction. Conclusions: These hypothesis-generating findings do not support changing anesthetic practice; the choice should remain individualized. Approximately 12% of attempted spinal anesthetics converted intra-operatively to general anesthesia\u2014a record-based observation, not a validated failure rate.<\/jats:p>","DOI":"10.3390\/jcm15134937","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T08:14:12Z","timestamp":1782375252000},"page":"4937","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Spinal Versus General Anesthesia for Acute Kidney Injury and Transfusion in One-Week-Staged Bilateral Total Knee Arthroplasty"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4307-3798","authenticated-orcid":false,"given":"Jaemin","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun Suh","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doo Sup","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Moldovan, F., and Moldovan, L. 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