title: Hospitalization for partial nephrectomy was not associated with intrathecal opioid analgesia: Retrospective analysis.
abstract: BACKGROUND
  The aim of this retrospective study is to test the hypothesis that the use of spinal analgesia shortens the length of hospital stay after partial nephrectomy.
  
  
  METHODS
  We reviewed all patients undergoing partial nephrectomy for malignancy through flank incision between January 1, 2008, and June 30, 2011. We excluded patients who underwent tumor thrombectomy, used sustained-release opioids, or had general anesthesia supplemented by epidural analgesia. Patients were grouped into "spinal" (intrathecal opioid injection for postoperative analgesia) versus "general anesthetic" group, and "early" discharge group (within 3 postoperative days) versus "late" group. Association between demographics, patient physical status, anesthetic techniques, and surgical complexity and hospital stay were analyzed using multivariable logistic regression analysis.
  
  
  RESULTS
  Of 380 patients, 158 (41.6%) were discharged "early" and 151 (39.7%) were "spinal" cases. Both spinal and early discharge groups had better postoperative pain control and used less postoperative systemic opioids. Spinal analgesia was associated with early hospital discharge, odds ratio 1.52, (95% confidence interval 1.00-2.30), P = 0.05, but in adjusted analysis was no longer associated with early discharge, 1.16 (0.73-1.86), P = 0.52. Early discharge was associated with calendar year, with more recent years being associated with early discharge.
  
  
  CONCLUSIONS
  Spinal analgesia combined with general anesthesia was associated with improved postoperative pain control during the 1(st) postoperative day, but not with shorter hospital stay following partial nephrectomy. Therefore, unaccounted practice changes that occurred during more recent times affected hospital stay.
authors.affiliation: Department of Anesthesiology, College of Medicine, Rochester, MN, USA.
authors.forename: Toby N
authors.initials: TN
authors.lastname: Weingarten
authors.affiliation: Mayo Clinic, College of Medicine, Rochester, MN, USA.
authors.forename: Serena B
authors.initials: SB
authors.lastname: Del Mundo
authors.affiliation: Department of Anesthesiology, College of Medicine, Rochester, MN, USA ; Department of Anesthesia, National University Hospital, National University Health System, Republic of Singapore.
authors.forename: Tze Yeng
authors.initials: TY
authors.lastname: Yeoh
authors.affiliation: Department of Anesthesiology, College of Medicine, Rochester, MN, USA.
authors.forename: Federica
authors.initials: F
authors.lastname: Scavonetto
authors.affiliation: Department of Urology, College of Medicine, Rochester, MN, USA.
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Leibovich
authors.affiliation: Department of Anesthesiology, College of Medicine, Rochester, MN, USA.
authors.forename: Juraj
authors.initials: J
authors.lastname: Sprung
keywords: Hospital length of stay; neuroaxial anesthesia; radical nephrectomy