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Application for ESRA Abstract Prizes:Background and Aims With an ageing population, the number of total hip arthroplasty (THA) procedures is steadily increasing, accompanied by a notable mortality rate of 5.8%. This study aimed to compare the economic impact of general anaesthesia (GA) versus spinal anaesthesia (SA) in patients undergoing THA in Croatia, focusing on overall hospital costs and transfusion-related outcomes.Methods A retrospective analysis was conducted using data from Clinical Hospital Zagreb. The study included 165 patients who underwent THA in 2012—64 under GA and 101 under SA. Total hospital costs were calculated, including material use, medications, blood transfusions, and postoperative complications. Transfusion rates and related expenses were also assessed.Results Total costs were significantly higher for the GA group (€44.58) compared to the SA group (€11.18) (p < 0.0001). Blood transfusion rates were 81.1% in the GA group and 62.9% in the SA group (p = 0.94), with the average cost of transfusion estimated at €54. Although transfusion rate differences were not statistically significant, SA was associated with reduced blood loss and overall economic burden.Conclusions Spinal anaesthesia in THA is associated with significantly lower hospital costs and reduced transfusion needs. Cost-saving strategies should include the wider use of regional anaesthesia, implementation of restrictive transfusion protocols, correction of preoperative anaemia (e.g., IV iron ± erythropoietin), use of tranexamic acid, and autologous transfusion techniques. Investing in training for regional anaesthesia could yield substantial economic and clinical benefits.