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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

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Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion and relevance

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.

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Authors and Affiliations

  1. 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

    M. M. Vu, R. D. Galiano, J. M. Souza, C. Du Qin & J. Y. S. Kim

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  1. M. M. Vu
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  2. R. D. Galiano
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  3. J. M. Souza
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  4. C. Du Qin
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  5. J. Y. S. Kim
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Correspondence to J. Y. S. Kim.

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The authors MV, RG, JS, CQ, and JK declare that they have no conflicts of interest directly related to this particular work.

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Vu, M.M., Galiano, R.D., Souza, J.M. et al. 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. Hernia 20, 517–525 (2016). https://doi.org/10.1007/s10029-015-1455-5

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  • DOI: https://doi.org/10.1007/s10029-015-1455-5

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