title: Regional anesthesia, time to hospital discharge, and in-hospital mortality: a propensity score matched analysis.
abstract: OBJECTIVE
  The anesthetic technique used during surgery can affect postoperative length of stay and outcomes, even after controlling for other clinically important factors. This study evaluated the impact of regional anesthesia (RA) compared with general anesthesia (GA) on the amount of time between leaving the operating room and hospital discharge and the odds of in-hospital mortality.
  
  
  METHODS
  Surgical patients admitted after surgery, who received RA, were matched to patients who received GA by propensity score in a 1:4 ratio. We measured the association between anesthetic technique and time to hospital discharge using Kaplan-Meier methods. In-hospital mortality was analyzed using a generalized estimating equation logistic regression model.
  
  
  RESULTS
  A total of 5870 inpatient surgical cases were analyzed; 1174 cases received RA and 4696 cases received GA. The median time to hospital discharge among patients who received RA was 67.6 hours compared with 71.9 hours among patients who received GA (P < 0.0001). A total of 86 cases died in the hospital after surgery; 7 were in the RA cohort and 79 were in the GA cohort. Receiving RA during surgery was associated with 64% lesser odds of dying in the hospital (odds ratio, 0.36; 95% confidence interval, 0.16-0.75), when adjusting for the number of postoperative days spent in the hospital.
  
  
  CONCLUSIONS
  The study data provide evidence that median time to discharge is shorter when RA is used instead of GA, controlling for other clinically important factors. Additionally, RA use during surgery was associated with a decrease in in-hospital mortality. When an appropriate option, RA may facilitate faster hospital discharge and improve patient outcomes.
authors.affiliation: From the *Department of Anesthesiology, Vanderbilt University Medical Center; Departments of †Biostatistics, ‡Biomedical Informatics, and §Surgery, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Bulka
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Shotwell
authors.forename: Rajnish K
authors.initials: RK
authors.lastname: Gupta
authors.forename: Warren S
authors.initials: WS
authors.lastname: Sandberg
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Ehrenfeld
mesh_terms: D000328:Adult; D000368:Aged; D000765:Anesthesia, Conduction / Q000379:methods*; D000768:Anesthesia, General; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000706:statistics & numerical data; D010351:Patient Discharge; D057216:Propensity Score; D012189:Retrospective Studies; D016896:Treatment Outcome