Jennie Meier1, Miles Berger2, Timothy Hogan3, Joan Reisch4, Herbert Zeh5, C Munro Cullum6, Simon C Lee4, Celette Sugg Skinner4, Cynthia J Brown7, Courtney J Balentine8. 1. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; North Texas VA Healthcare System, Dallas, TX, USA. Electronic address: Jennie.meier@utsouthwestern.edu. 2. Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA. 3. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA. 4. Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA. 5. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. 6. Psychology Division, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA. 7. Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham/Atlanta VA Geriatric Research, Education, And Clinical Center, Birmingham, AL, USA. 8. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; North Texas VA Healthcare System, Dallas, TX, USA.
Abstract
BACKGROUND: Frailty predisposes patients to poor postoperative outcomes. We evaluated whether using local rather than general anesthesia for hernia repair could mitigate effects of frailty. METHODS: We used the Risk Analysis Index (RAI) to identify 8,038 frail patients in the 1998-2018 Veterans Affairs Surgical Quality Improvement Program database who underwent elective, open unilateral inguinal hernia repair under local or general anesthesia. Our outcome of interest was the incidence of postoperative complications. RESULTS: In total, 5,188 (65%) patients received general anesthesia and 2,850 (35%) received local. Local anesthesia was associated with a 48% reduction in complications (OR 0.52, 95%CI 0.38-0.72). Among the frailest patients (RAI≥70), predicted probability of a postoperative complication ranged from 22 to 33% with general anesthesia, compared to 13-21% with local. CONCLUSIONS: Local anesthesia was associated with a ∼50% reduction in postoperative complications in frail Veterans. Given the paucity of interventions for frail patients, there is an urgent need for a randomized trial comparing effects of anesthesia modality on postoperative complications in this vulnerable population.
BACKGROUND: Frailty predisposes patients to poor postoperative outcomes. We evaluated whether using local rather than general anesthesia for hernia repair could mitigate effects of frailty. METHODS: We used the Risk Analysis Index (RAI) to identify 8,038 frail patients in the 1998-2018 Veterans Affairs Surgical Quality Improvement Program database who underwent elective, open unilateral inguinal hernia repair under local or general anesthesia. Our outcome of interest was the incidence of postoperative complications. RESULTS: In total, 5,188 (65%) patients received general anesthesia and 2,850 (35%) received local. Local anesthesia was associated with a 48% reduction in complications (OR 0.52, 95%CI 0.38-0.72). Among the frailest patients (RAI≥70), predicted probability of a postoperative complication ranged from 22 to 33% with general anesthesia, compared to 13-21% with local. CONCLUSIONS: Local anesthesia was associated with a ∼50% reduction in postoperative complications in frail Veterans. Given the paucity of interventions for frail patients, there is an urgent need for a randomized trial comparing effects of anesthesia modality on postoperative complications in this vulnerable population.
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