TY - JOUR
T1 - Using Local Anesthesia for Inguinal Hernia Repair Reduces Complications in Older Patients
AU - Balentine, Courtney J.
AU - Meier, Jennie
AU - Berger, Miles
AU - Reisch, Joan
AU - Cullum, Munro
AU - Lee, Simon C.
AU - Skinner, Celette Sugg
AU - Brown, Cynthia J.
N1 - Funding Information:
The authors would like to thank Dave Primm for help in editing this manuscript. This work was supported by a GEMSSTAR grant from the National Institute of Aging (1R03AG056330; for C.J.B.). Dr. Brown was supported, in part, by a VA Rehabilitation R&D Merit Award (1 I01 RX001995). MB acknowledges funding support from National Institutes of Health Beeson K76AG057022.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/2
Y1 - 2021/2
N2 - Background: 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 the superiority of the former. Although patients aged 65 y 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. Materials and methods: 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 to 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 y, 55-64 y, 65-74 y, and ≥75 y. Results: Using local rather than general anesthesia was associated with a 0.6% reduction in postoperative complications in patients aged 75+ y (95% CI –0.11 to –1.13) but not in younger patients. Local anesthesia was associated with faster operative time (2.5 min - 4.7 min) in patients <75 y but not in patients aged 75+ y. 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. Conclusions: 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.
AB - Background: 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 the superiority of the former. Although patients aged 65 y 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. Materials and methods: 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 to 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 y, 55-64 y, 65-74 y, and ≥75 y. Results: Using local rather than general anesthesia was associated with a 0.6% reduction in postoperative complications in patients aged 75+ y (95% CI –0.11 to –1.13) but not in younger patients. Local anesthesia was associated with faster operative time (2.5 min - 4.7 min) in patients <75 y but not in patients aged 75+ y. 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. Conclusions: 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.
KW - General anesthesia
KW - Hernia repair
KW - Local anesthesia
KW - Older adult
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U2 - 10.1016/j.jss.2020.08.054
DO - 10.1016/j.jss.2020.08.054
M3 - Article
C2 - 33002663
AN - SCOPUS:85091591783
VL - 258
SP - 64
EP - 72
JO - Journal of Surgical Research
JF - Journal of Surgical Research
SN - 0022-4804
ER -