J Meier1,2,3, A Stevens4,5,6, M Berger7, T P Hogan4,8,9, J Reisch8, C M Cullum10, S C Lee8, C S Skinner8, H Zeh4, C J Brown11, C J Balentine4,5,6. 1. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. Jennie.meier@utsouthwestern.edu. 2. North Texas VA Health Care System, 4500 S. Lancaster Road, Dallas, TX, 75216, USA. Jennie.meier@utsouthwestern.edu. 3. Implementation, and Novel Interventions (S-COIN), University of Texas Southwestern Surgical Center for Outcomes, Dallas, TX, USA. Jennie.meier@utsouthwestern.edu. 4. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. 5. North Texas VA Health Care System, 4500 S. Lancaster Road, Dallas, TX, 75216, USA. 6. Implementation, and Novel Interventions (S-COIN), University of Texas Southwestern Surgical Center for Outcomes, Dallas, TX, USA. 7. Department of Anesthesiology, Duke University, Durham, NC, USA. 8. Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA. 9. Center for Healthcare Organization and Implementation Research, VA Bedford Health Care System, US Department of Veterans Affairs, Bedford, MA, USA. 10. Departments of Psychiatry, Neurology, and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. 11. Department of Medicine, LA State University-New Orleans, New Orleans, Louisiana, USA.
Abstract
PURPOSE: In 2003, randomized trials demonstrated potentially improved outcomes when local instead of general anesthesia is used for inguinal hernia repair. Our study aimed to evaluate how the use of local anesthesia for this procedure changed over time following the publication of the trials' level 1 evidence. METHODS: We used the 1998-2018 Veterans Affairs Surgical Quality Improvement Program database to identify adults who underwent open, unilateral inguinal hernia repair under local or general anesthesia. Our primary outcome was the percentage of cases performed under local anesthesia. We used a time-series design to examine the trend and rate of change of the use of local anesthesia. RESULTS: We included 97,437 veterans, of which 22,333 (22.9%) had hernia surgery under local anesthesia. The median age of veterans receiving local anesthesia remained stable at 64-67 years over time. The use of local anesthesia decreased steadily, from 38.2% at the beginning year to 15.1% in the final year (P < 0.0001). The publication of results from randomized trials (in 2003) did not appear to increase the overall use or change the rate of decline in the use of local anesthesia. Overall, we found that the use of local anesthesia decreased by about 1.5% per year. CONCLUSION: The utilization of local anesthesia for inguinal hernia repair in the VA has steadily declined over the last 20 + years, despite data showing equivalence or superiority to general anesthesia. Future studies should explore barriers to the use of local anesthesia for hernia repair.
PURPOSE: In 2003, randomized trials demonstrated potentially improved outcomes when local instead of general anesthesia is used for inguinal hernia repair. Our study aimed to evaluate how the use of local anesthesia for this procedure changed over time following the publication of the trials' level 1 evidence. METHODS: We used the 1998-2018 Veterans Affairs Surgical Quality Improvement Program database to identify adults who underwent open, unilateral inguinal hernia repair under local or general anesthesia. Our primary outcome was the percentage of cases performed under local anesthesia. We used a time-series design to examine the trend and rate of change of the use of local anesthesia. RESULTS: We included 97,437 veterans, of which 22,333 (22.9%) had hernia surgery under local anesthesia. The median age of veterans receiving local anesthesia remained stable at 64-67 years over time. The use of local anesthesia decreased steadily, from 38.2% at the beginning year to 15.1% in the final year (P < 0.0001). The publication of results from randomized trials (in 2003) did not appear to increase the overall use or change the rate of decline in the use of local anesthesia. Overall, we found that the use of local anesthesia decreased by about 1.5% per year. CONCLUSION: The utilization of local anesthesia for inguinal hernia repair in the VA has steadily declined over the last 20 + years, despite data showing equivalence or superiority to general anesthesia. Future studies should explore barriers to the use of local anesthesia for hernia repair.
Authors: Patrick J O'Dwyer; Michael G Serpell; Keith Millar; Caron Paterson; David Young; Alan Hair; Carol-Ann Courtney; Paul Horgan; Sudhir Kumar; Andrew Walker; Ian Ford Journal: Ann Surg Date: 2003-04 Impact factor: 12.969
Authors: Sanjay Mohanty; Ronnie A Rosenthal; Marcia M Russell; Mark D Neuman; Clifford Y Ko; Nestor F Esnaola Journal: J Am Coll Surg Date: 2016-01-04 Impact factor: 6.113
Authors: Courtney J Balentine; Jennie Meier; Miles Berger; Timothy P Hogan; Joan Reisch; Munro Cullum; Herbert Zeh; Simon C Lee; Celette Sugg Skinner; Cynthia J Brown Journal: Am J Surg Date: 2020-08-25 Impact factor: 2.565