Using Local Anesthesia for Inguinal Hernia Repair Reduces Complications in Older Patients.
Using Local Anesthesia for Inguinal Hernia Repair Reduces Complications in Older Patients.
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DOI：
10.1016/j.jss.2020.08.054
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Brown CJ
中科院分区：
文献类型：
--
作者：
Balentine CJ;Meier J;Berger M;Reisch J;Cullum M;Lee SC;Skinner CS;Brown CJ
Inguinal hernia repair is the most common general surgery operation in the United States. Nearly 80% of inguinal hernia operations are performed under general anesthesia versus 15%–20% using local anesthesia, despite the absence of evidence for superiority of the former. Although patients aged 65 years and older are expected to benefit from avoiding general anesthesia, this presumed benefit has not been adequately studied. We hypothesized that the benefits of local over general anesthesia for inguinal hernia repair would increase with age. We analyzed 87,794 patients in the American College of Surgeons National Surgical Quality Improvement Project who had elective inguinal hernia repair under local or general anesthesia from 2014–2018, and we used propensity scores to adjust for known confounding. We compared postoperative complications, 30-day readmissions, and operative time for patients aged <55 years, 55–64 years, 65–74 years, and ≥75 years. Using local rather than general anesthesia was associated with a 0.6% reduction in postoperative complications in patients aged 75+ years (95% CI −0.11 to −1.13) but not in younger patients. Local anesthesia was associated with faster operative time (2.5 minutes – 4.7 minutes) in patients <75 years but not in patients aged 75+ years. Readmissions did not differ by anesthesia modality in any age group. Projected national cost savings for greater use of local anesthesia ranged from $9 million to $45 million annually. Surgeons should strongly consider using local anesthesia for inguinal hernia repair in older patients and in younger patients because it is associated with significantly reduced complications and substantial cost savings.
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