A multi-institutional, propensity-score-matched comparison of post-operative outcomes between general anesthesia and monitored anesthesia care with intravenous sedation in umbilical hernia repair

M. M. Vu, R. D. Galiano, J. M. Souza, C. Du Qin, J. Y.S. Kim*

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Purpose: 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 widespread concern. There is a paucity of the literature examining umbilical hernia repairs (UHR) and optimal anesthesia choice, despite its importance in determining clinical outcomes. Methods: A retrospective analysis of anesthesia type in UHR was performed in the National Surgical Quality Improvement Program 2005–2013 database. General anesthesia and MAC/IV groups were propensity-score-matched (PSM) to reduce treatment selection bias. Surgical complications, medical complications, and post-operative hospital stays exceeding 1 day were the primary outcomes of interest. Pre-operative characteristics and post-operative outcomes were compared between the two anesthesia groups using univariate and multivariate statistics. Results: PSM removed all observed differences between the two groups (p > 0.05 for all tracked pre-operative characteristics). MAC/IV cases required fewer post-operative hospital stays exceeding 1 day (3.5 vs 6.3 %, p < 0.001). Univariate analysis showed that 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 logistic regression, MAC/IV was revealed to yield significantly lower chances of overall medical complications (OR = 0.654, p = 0.046). Conclusion and relevance: UHR under MAC/IV causes fewer medical complications and reduces post-operative hospital stays compared to general anesthesia. The implications for surgeons and patients are broad, including improved surgical safety, cost-effective care, and patient satisfaction.

Original languageEnglish (US)
Pages (from-to)517-525
Number of pages9
JournalHernia
Volume20
Issue number4
DOIs
StatePublished - Aug 1 2016

Keywords

  • 30-day complications
  • General anesthesia
  • Hospital stay
  • Monitored anesthesia care
  • Umbilical hernia repair

ASJC Scopus subject areas

  • Surgery

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