General Versus Neuraxial Anesthesia for Appendectomy: A Multicenter International Study
World Journal of Surgery, vol. 45, pp. 3295–3301
Abstract
BACKGROUND: In resource-limited countries, open appendectomy is still performed under general anesthesia (GA) or neuraxial anesthesia (NA). We sought to compare the postoperative outcomes of appendectomy under NA versus GA. METHODS: We conducted a post hoc analysis of the International Patterns of Opioid Prescribing (iPOP) multicenter study. All patients ≥ 16 years-old who underwent an open appendectomy between October 2016 and March 2017 in one of the 14 participating hospitals were included. Patients were stratified into two groups: NA-defined as spinal or epidural-and GA. All-cause morbidity, hospital length of stay (LOS), and pain severity were assessed using univariate analysis followed by multivariable logistic regression adjusting for the following preoperative characteristics: age, gender, body mass index (BMI), smoking, history of opioid use, emergency status, and country. RESULTS: A total of 655 patients were included, 353 of which were in the NA group and 302 in the GA group. The countries operating under NA were Colombia (39%), Thailand (31%), China (23%), and Brazil (7%). Overall, NA patients were younger (mean age (SD): 34.5 (14.4) vs. 40.7 (17.9), p-value < 0.001) and had a lower BMI (mean (SD): 23.5 (3.8) vs. 24.3 (5.2), p-value = 0.040) than GA patients. On multivariable analysis, NA was independently associated with less postoperative complications (OR, 95% CI: 0.30 [0.10-0.94]) and shorter hospital LOS (LOS > 3 days, OR, 95% CI: 0.47 [0.32-0.68]) compared to GA. There was no difference in postoperative pain severity between the two techniques. CONCLUSIONS: Open appendectomy performed under NA is associated with improved outcomes compared to that performed under GA. Further randomized controlled studies should examine the safety and value of NA in lower abdominal surgery.
Authors 24
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Harvard University · Massachusetts General Hospital
Affiliation as printed
Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Harvard Medical School Massachusetts General Hospital 165 Cambridge Street, Suite 810 02114 Boston MA USA
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Harvard University · Massachusetts General Hospital
Affiliation as printed
Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Harvard Medical School Massachusetts General Hospital 165 Cambridge Street, Suite 810 02114 Boston MA USA
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Harvard University · Massachusetts General Hospital
Affiliation as printed
Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Harvard Medical School Massachusetts General Hospital 165 Cambridge Street, Suite 810 02114 Boston MA USA
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Harvard University · Massachusetts General Hospital
Affiliation as printed
Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Harvard Medical School Massachusetts General Hospital 165 Cambridge Street, Suite 810 02114 Boston MA USA
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Harvard University · Shanghai Jiao Tong University · Massachusetts General Hospital · Shanghai Sixth People's Hospital
Affiliation as printed
Department of General Surgery Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai People's Republic of China
Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Harvard Medical School Massachusetts General Hospital 165 Cambridge Street, Suite 810 02114 Boston MA USA
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Harvard University · Massachusetts General Hospital
Affiliation as printed
Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Harvard Medical School Massachusetts General Hospital 165 Cambridge Street, Suite 810 02114 Boston MA USA
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Siriraj Hospital · Harvard University · Mahidol University · Massachusetts General Hospital
Affiliation as printed
Division of Acute Care and Ambulatory Surgery, Siriraj Hospital Mahidol University Bangkok Thailand
Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Harvard Medical School Massachusetts General Hospital 165 Cambridge Street, Suite 810 02114 Boston MA USA
Division of Acute Care and Ambulatory Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Harvard University · Massachusetts General Hospital
Affiliation as printed
Department of Anesthesiology Faculty of Medicine Bangkok Thailand
Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Harvard Medical School Massachusetts General Hospital 165 Cambridge Street, Suite 810 02114 Boston MA USA
Department of Anesthesiology, Faculty of Medicine, Bangkok, Thailand
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Harvard University · Massachusetts General Hospital
Affiliation as printed
Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Harvard Medical School Massachusetts General Hospital 165 Cambridge Street, Suite 810 02114 Boston MA USA
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Hospital Departamental de Villavicencio
Affiliation as printed
Hospital Departamental Villavicencio Villavicencio Colombia
Hospital Departamental Villavicencio, Villavicencio, Colombia
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Tongji University · Shanghai Tenth People's Hospital
Affiliation as printed
Department of General Surgery, Shanghai Tenth People's Hospital Tongji University School of Medicine Shanghai People's Republic of China
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Shanghai Jiao Tong University · Shanghai Sixth People's Hospital
Affiliation as printed
Department of General Surgery Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai People's Republic of China
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Tongji University · Shanghai Tenth People's Hospital
Affiliation as printed
Department of General Surgery, Shanghai Tenth People's Hospital Tongji University School of Medicine Shanghai People's Republic of China
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Second Military Medical University · Shanghai Changzheng Hospital
Affiliation as printed
Department of Colorectal Surgery, Changzheng Hospital Navy Medical University Shanghai People's Republic of China
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Tongji University · Shanghai East Hospital
Affiliation as printed
Department of Emergency Surgery Shanghai East Hospital of Tongji University Shanghai People's Republic of China
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King Chulalongkorn Memorial Hospital
Affiliation as printed
Department of Surgery King Chulalongkorn Memorial Hospital Bangkok Thailand
Department of Surgery, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Leiden University Medical Center · Alrijne Ziekenhuis
Affiliation as printed
Department of Surgery Alrijne Hospital, Leiden University Medical Center Leiden The Netherlands
Department of Surgery, Alrijne Hospital, Leiden University Medical Center, Leiden, The Netherlands
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Affiliation as printed
Department of Surgery Hospital Brasil Rede D´Or São Paulo SP Brazil
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Pontifícia Universidade Católica de São Paulo
Affiliation as printed
Department of Surgery, Post‐Graduation Program Catholic University of São Paulo PUCSP‐Sorocaba, Hospital Servidor Publico Estadual IAMSPE, Hospital Moriah São Paulo SP Brazil
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Siriraj Hospital · Mahidol University
Affiliation as printed
Division of Acute Care and Ambulatory Surgery, Siriraj Hospital Mahidol University Bangkok Thailand
Division of Acute Care and Ambulatory Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Johns Hopkins University · Johns Hopkins Medicine
Affiliation as printed
Division of Acute Care Surgery, Emergency General Surgery The Johns Hopkins University Baltimore MD USA
Division of Acute Care Surgery, Emergency General Surgery, The Johns Hopkins University, Baltimore, USA
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Affiliation as printed
Department of Surgery, College of Medicine University of Arizona Tucson AZ USA
Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
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Affiliation as printed
Department of Surgery American University of Beirut Beirut Lebanon
Department of Surgery, American University of Beirut, Beirut, Lebanon
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Haytham M. A. Kaafarani corresponding
Harvard University · Massachusetts General Hospital
Affiliation as printed
Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Harvard Medical School Massachusetts General Hospital 165 Cambridge Street, Suite 810 02114 Boston MA USA
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