title: 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.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors: Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 675 North St. Clair Street Galter Suite 19-250, Chicago, IL, 60611, USA.
authors: M M
authors: MM
authors: Vu
authors: Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 675 North St. Clair Street Galter Suite 19-250, Chicago, IL, 60611, USA.
authors: R D
authors: RD
authors: Galiano
authors: Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 675 North St. Clair Street Galter Suite 19-250, Chicago, IL, 60611, USA.
authors: J M
authors: JM
authors: Souza
authors: Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 675 North St. Clair Street Galter Suite 19-250, Chicago, IL, 60611, USA.
authors: C
authors: C
authors: Du Qin
authors: Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, 675 North St. Clair Street Galter Suite 19-250, Chicago, IL, 60611, USA. jokim@nm.org.
authors: J Y S
authors: JY
authors: Kim
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D016292:Procedural Sedation; D005260:Female; D006554:Hernia, Umbilical / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011184:Postoperative Period; D057216:Propensity Score; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: 30-day complications; General anesthesia; Hospital stay; Monitored anesthesia care; Umbilical hernia repair