Courtney J Balentine1, Jennie Meier2, Miles Berger3, Timothy P Hogan4, Joan Reisch5, Munro Cullum6, Herbert Zeh7, Simon C Lee5, Celette Sugg Skinner5, Cynthia J Brown8. 1. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; VA North Texas Healthcare System, Dallas, TX, USA. 2. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; VA North Texas Healthcare System, Dallas, TX, USA. Electronic address: Jennie.meier@utsouthwestern.edu. 3. Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA. 4. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA; Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, US Department of Veterans Affairs, Bedford, MA, USA. 5. Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA. 6. Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA. 7. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. 8. Birmingham/Atlanta Veterans Affairs Geriatric Research, Education and Clinical Care Center, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Comprehensive Center for Healthy Aging Birmingham, AL, USA.
Abstract
BACKGROUND: Inguinal hernia repair is the most common general surgery procedure and can be performed under local or general anesthesia. We hypothesized that using local rather than general anesthesia would improve outcomes, especially for older adults. METHODS: This is a retrospective review of 97,437 patients in the Veterans Affairs Surgical Quality Improvement Program who had open inguinal hernia surgery under local or general anesthesia. Outcomes included 30-day postoperative complications, operative time, and recovery time. RESULTS: Our cohort included 22,333 (23%) Veterans who received local and 75,104 (77%) who received general anesthesia. Mean age was 62 years. Local anesthesia was associated with a 37% decrease in the odds of postoperative complications (95% CI 0.54-0.73), a 13% decrease in operative time (95% CI 17.5-7.5), and a 27% shorter recovery room stay (95% CI 27.5-25.5), regardless of age. CONCLUSIONS: Using local rather than general anesthesia is associated with a profound decrease in complications (equivalent to "de-aging" patients by 30 years) and could significantly reduce costs for this common procedure.
BACKGROUND: Inguinal hernia repair is the most common general surgery procedure and can be performed under local or general anesthesia. We hypothesized that using local rather than general anesthesia would improve outcomes, especially for older adults. METHODS: This is a retrospective review of 97,437 patients in the Veterans Affairs Surgical Quality Improvement Program who had open inguinal hernia surgery under local or general anesthesia. Outcomes included 30-day postoperative complications, operative time, and recovery time. RESULTS: Our cohort included 22,333 (23%) Veterans who received local and 75,104 (77%) who received general anesthesia. Mean age was 62 years. Local anesthesia was associated with a 37% decrease in the odds of postoperative complications (95% CI 0.54-0.73), a 13% decrease in operative time (95% CI 17.5-7.5), and a 27% shorter recovery room stay (95% CI 27.5-25.5), regardless of age. CONCLUSIONS: Using local rather than general anesthesia is associated with a profound decrease in complications (equivalent to "de-aging" patients by 30 years) and could significantly reduce costs for this common procedure.
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