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Is there a benefit to additional neuroaxial anesthesia in open nephrectomy? A prospective NSQIP propensity score analysis

  • Urology - Original Paper
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Abstract

Introduction

Neuroaxial (i.e., spinal, regional, epidural) anesthesia has been shown to be associated with reduced readmission rate, decreased hospital stay, and decreased overall complication rate in orthopedic and gynecologic surgery. Our aim was to identify differences in intra- and postoperative complications, length of stay and readmission rates in open nephrectomy patients managed with neuroaxial anesthesia.

Materials and methods

Utilizing National Surgical Quality Inpatient Program (NSQIP) database, we identified patients who have undergone an open nephrectomy between 2014 and 2017. Patients were further subdivided based on anesthesia modality. We used the propensity score-matching (PSM) method to adjust for baseline differences among patients who received general anesthesia alone and those with additional neuroaxial anesthesia. Using step-wise multivariable logistic regression, we identified preoperative and intraoperative predictors associated with 30-day procedure-related readmission, complications, and postoperative length of stay.

Results

Out of 3,633 patients identified, 2346 patients met our inclusion and exclusion criteria. There was no difference in baseline characteristics after propensity score matching between general and additional neuroaxial anesthesia. Postoperative outcomes including: procedure-related readmission, rate of reoperation, operative time, all complications were similar between the groups. Adjuvant neuroaxial anesthesia group did experience a prolonged postoperative hospital stay that was statistically significant as compared to patients with general anesthesia alone [5.3 (3.5) days vs 4.8 (2.9) days, p = 0.007].

Compared to GA alone after multivariable logistic regression, neuroaxial anesthesia was not statistically significant for readmission (p = 0.909), any complication (p = 0.505), but did showed increased odds ratio of prolonged postoperative stay [aOR 1.107, 95% CI 1.042–1.176, p = 0.001] after adjusting for multiple factors.

Conclusion

Using 2014–2017 NSQIP database, we were able to demonstrate no additional reduction in complication or readmission rate in patients with neuroaxial anesthesia as compared to general anesthesia alone. Furthermore, patients who did receive neuroaxial anesthesia experienced a longer postoperative course.

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Abbreviations

ERAS:

Enhanced recovery after surgery

NICE:

National Institute of Health and Care Excellence

aOR:

Adjusted odds ratio

RB:

Regional block

ASA:

American Society of Anesthesiology

DVT:

Deep-vein thrombosis

VTE:

Venous thromboembolism

NA:

Neuroaxial anesthesia

CPT:

Current procedural terminology

NSQIP:

National Surgical Quality Improvement Program

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Authors and Affiliations

  1. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Amr Mahran & Michael Wang

  2. Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Amr Mahran, Kirtishri Mishra, Danly Omil-Lima, Bissan Abboud, Michael Wang, Jason Jankowski, Lee Ponsky & Laura Bukavina

  3. Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Jason Jankowski & Lee Ponsky

  4. Glickman Urology and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

    Robert Abouassaly

  5. Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA

    Robert Abouassaly

  6. Metro Health Medical Center, Cleveland, OH, USA

    Irma Lengu

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  1. Amr Mahran
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Correspondence to Laura Bukavina.

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Mahran, A., Mishra, K., Omil-Lima, D. et al. Is there a benefit to additional neuroaxial anesthesia in open nephrectomy? A prospective NSQIP propensity score analysis. Int Urol Nephrol 51, 1481–1489 (2019). https://doi.org/10.1007/s11255-019-02208-z

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