M. M. Vu1, R. D. Galiano1, J. Souza1, C. Du Qin1, J. Y. Kim1 1Northwestern University Feinberg School Of Medicine,Chicago, IL, USA
Introduction:
Monitored anesthesia care with intravenous sedation (MAC/IV), recently proposed as a good choice for hernia repair, has faster recovery and better patient satisfaction than general anesthesia. However the possibility of oversedation and respiratory distress is a classic concern. There is a paucity of literature examining umbilical hernia repairs (UHR) and optimal choice of anesthesia, despite it being a critical factor driving clinical outcomes. We aimed to evaluate whether MAC/IV versus general anesthesia independently affects postoperative outcomes following UHR.
Methods:
A multi-institutional retrospective analysis of anesthesia type and UHR was performed using National Surgical Quality Improvement Program (NSQIP), a surgical database surveying over 300 institutions, from 2005 to 2013. UHRs were identified as cases with CPT code 49585, 49587, 49652, or 49653, and also ICD-9 code 551.1, 552.1, or 553.1. Only cases performed by general surgery using general anesthesia or MAC/IV were included. Cases with outlying BMI <10 or >100, operative time longer than three hours, any missing values in analyzed variables, or multiple concurrent operations were excluded. General anesthesia and MAC/IV groups were propensity-score-matched (PSM) to reduce treatment selection bias. Preoperative characteristics and postoperative outcomes were compared between the anesthesia-type groups with univariate and multivariate statistics. Tracked outcomes included medical complications, surgical complications, operative duration, and postoperative hospital stays greater than 1 day.
Results:
49,942 cases were analyzed, 13.8% of which were performed under MAC/IV. After PSM, 27,334 cases remained for statistical analysis. PSM removed all observed differences between the intervention groups (p>0.05 for all tracked preoperative characteristics). MAC/IV cases required fewer >1 day hospital stays (3.5% vs 6.3%, p<0.001). Univariate analysis showed overall complication rate did not differ (1.7% vs 1.8%, p=0.569), however MAC/IV cases resulted in fewer incidences of septic shock (<0.1% vs 0.1%, p=0.016). After multivariate regression, MAC/IV cases were revealed to have significantly lower odds of medical complication, with an adjusted odds ratio of 0.654 (p=0.046).
Conclusion:
UHR under MAC/IV causes fewer medical complications and reduces postoperative hospital stays compared to general anesthesia. The implications for surgeons and patients are broad, including improved surgical safety, cost-effective care, and patient satisfaction.
