title: Locoregional versus general anesthesia for open inguinal herniorrhaphy: a National Surgical Quality Improvement Program analysis.
abstract: Our objective was to study outcomes associated with open inguinal herniorrhaphy performed under locoregional (LR) versus general anesthesia (GA). National Surgical Quality Improvement Program (NSQIP) data from 2005 to 2009 was queried to capture patients undergoing initial unilateral  inguinal herniorrhaphy. We excluded patients with incarcerated/strangulated hernia or those undergoing a concomitant procedure. Outcomes were anesthesia and operative times, postoperative admission, and 30-day morbidity. Using the entire NSQIP sample, forward stepwise multivariate regression  analysis was used to compare outcomes between patients receiving LR versus GA after adjustment for patient demographics and comorbid diagnoses. Outcomes were also compared for a smaller subgroup of patients propensity-matched for receiving LR anesthesia. A total of 25,213 patients were  analyzed (16,282 GA and 8,931 LR). Patients in the LR group had a higher incidence of comorbid illnesses and were more likely to have an American Society of Anesthesiologists classification ≥ 3. Multivariate analyses demonstrated that LR anesthetic is associated with shorter anesthetic  and operative times and a lower hospital admission rate. Comparison using a propensity-matched cohort for undergoing LR anesthesia confirms that these patients had significantly shorter anesthesia (32 vs 38 min, P < 0.0001) and operative times (53.3 vs 57.2 min, P  < 0.0001), as well as a significantly reduced rate of postoperative admission (5.9% vs 10.9%, P < 0.0001) and 30-day morbidity (0.9% vs 1.3%, P < 0.05). Our analysis of NSQIP suggests that, compared with general anesthesia, the locoregional technique is  associated with shorter anesthesia and operative times, reduced need for postoperative hospital admission, and a small but significant reduction in postoperative morbidity.
authors: Department of Surgery, Duke University Medical Center, Durham, North Carolina 27707, USA.
authors: Syamal D
authors: SD
authors: Bhattacharya
authors: Steven N
authors: SN
authors: Vaslef
authors: Theodore N
authors: TN
authors: Pappas
authors: John E
authors: JE
authors: Scarborough
mesh_terms: D000328:Adult; D000368:Aged; D000765:Anesthesia, Conduction; D000768:Anesthesia, General; D000772:Anesthesia, Local; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000592:standards*; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D058996:Quality Improvement; D016896:Treatment Outcome; D014481:United States