Mohamad El Moheb1, Kelsey Han1, Kerry Breen1, Majed El Hechi1, Zhenyi Jia1,2, Ava Mokhtari1, Napaporn Kongkaewpaisan1,3, Manasnun Kongwibulwut1,4, Gabriel Rodriguez1, Camilo Ortega5, Huanlong Qin6, Jun Yang2, Renyuan Gao6, Zhiguo Wang7, Zhiguang Gao8, Supparerk Prichayudh9, Gwendolyn M van der Wilden10, Stephanie Santin11, Marcelo A F Ribeiro12, Napakadol Noppakunsomboom3, Joseph V Sakran13, Bellal Joseph14, Ramzi Alami15, Haytham M A Kaafarani16. 1. Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA. 2. Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China. 3. Division of Acute Care and Ambulatory Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand. 4. Department of Anesthesiology, Faculty of Medicine, Bangkok, Thailand. 5. Hospital Departamental Villavicencio, Villavicencio, Colombia. 6. Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China. 7. Department of Colorectal Surgery, Changzheng Hospital, Navy Medical University, Shanghai, People's Republic of China. 8. Department of Emergency Surgery, Shanghai East Hospital of Tongji University, Shanghai, People's Republic of China. 9. Department of Surgery, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. 10. Department of Surgery, Alrijne Hospital, Leiden University Medical Center, Leiden, The Netherlands. 11. Department of Surgery, Hospital Brasil Rede D´Or, São Paulo, SP, Brazil. 12. Department of Surgery, Post-Graduation Program, Catholic University of São Paulo PUCSP-Sorocaba, Hospital Servidor Publico Estadual IAMSPE, Hospital Moriah, São Paulo, SP, Brazil. 13. Division of Acute Care Surgery, Emergency General Surgery, The Johns Hopkins University, Baltimore, MD, USA. 14. Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. 15. Department of Surgery, American University of Beirut, Beirut, Lebanon. 16. Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Harvard Medical School, Massachusetts General Hospital, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA. hkaafarani@mgh.harvard.edu.
Abstract
BACKGROUND: In resource-limited countries, open appendectomy is still performed under general anesthesia (GA) or neuraxial anesthesia (NA). We sought to compare the postoperative outcomes of appendectomy under NA versus GA. METHODS: We conducted a post hoc analysis of the International Patterns of Opioid Prescribing (iPOP) multicenter study. All patients ≥ 16 years-old who underwent an open appendectomy between October 2016 and March 2017 in one of the 14 participating hospitals were included. Patients were stratified into two groups: NA-defined as spinal or epidural-and GA. All-cause morbidity, hospital length of stay (LOS), and pain severity were assessed using univariate analysis followed by multivariable logistic regression adjusting for the following preoperative characteristics: age, gender, body mass index (BMI), smoking, history of opioid use, emergency status, and country. RESULTS:A total of 655 patients were included, 353 of which were in the NA group and 302 in the GA group. The countries operating under NA were Colombia (39%), Thailand (31%), China (23%), and Brazil (7%). Overall, NA patients were younger (mean age (SD): 34.5 (14.4) vs. 40.7 (17.9), p-value < 0.001) and had a lower BMI (mean (SD): 23.5 (3.8) vs. 24.3 (5.2), p-value = 0.040) than GA patients. On multivariable analysis, NA was independently associated with less postoperative complications (OR, 95% CI: 0.30 [0.10-0.94]) and shorter hospital LOS (LOS > 3 days, OR, 95% CI: 0.47 [0.32-0.68]) compared to GA. There was no difference in postoperative pain severity between the two techniques. CONCLUSIONS: Open appendectomy performed under NA is associated with improved outcomes compared to that performed under GA. Further randomized controlled studies should examine the safety and value of NA in lower abdominal surgery.
RCT Entities:
BACKGROUND: In resource-limited countries, open appendectomy is still performed under general anesthesia (GA) or neuraxial anesthesia (NA). We sought to compare the postoperative outcomes of appendectomy under NA versus GA. METHODS: We conducted a post hoc analysis of the International Patterns of Opioid Prescribing (iPOP) multicenter study. All patients ≥ 16 years-old who underwent an open appendectomy between October 2016 and March 2017 in one of the 14 participating hospitals were included. Patients were stratified into two groups: NA-defined as spinal or epidural-and GA. All-cause morbidity, hospital length of stay (LOS), and pain severity were assessed using univariate analysis followed by multivariable logistic regression adjusting for the following preoperative characteristics: age, gender, body mass index (BMI), smoking, history of opioid use, emergency status, and country. RESULTS: A total of 655 patients were included, 353 of which were in the NA group and 302 in the GA group. The countries operating under NA were Colombia (39%), Thailand (31%), China (23%), and Brazil (7%). Overall, NA patients were younger (mean age (SD): 34.5 (14.4) vs. 40.7 (17.9), p-value < 0.001) and had a lower BMI (mean (SD): 23.5 (3.8) vs. 24.3 (5.2), p-value = 0.040) than GA patients. On multivariable analysis, NA was independently associated with less postoperative complications (OR, 95% CI: 0.30 [0.10-0.94]) and shorter hospital LOS (LOS > 3 days, OR, 95% CI: 0.47 [0.32-0.68]) compared to GA. There was no difference in postoperative pain severity between the two techniques. CONCLUSIONS: Open appendectomy performed under NA is associated with improved outcomes compared to that performed under GA. Further randomized controlled studies should examine the safety and value of NA in lower abdominal surgery.