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International Urology and Nephrology

, Volume 51, Issue 9, pp 1481–1489 | Cite as

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

  • Amr Mahran
  • Kirtishri Mishra
  • Danly Omil-Lima
  • Bissan Abboud
  • Michael Wang
  • Jason Jankowski
  • Robert Abouassaly
  • Lee Ponsky
  • Irma Lengu
  • Laura BukavinaEmail author
Urology - Original Paper

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.

Keywords

Renal cell Kidney cancer Neuroaxial anesthesia 

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

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

All the authors declare that he/she have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Supplementary material

11255_2019_2208_MOESM1_ESM.docx (124 kb)
Supplementary file1 (DOCX 124 kb)
11255_2019_2208_MOESM2_ESM.docx (52 kb)
Supplementary file2 (DOCX 52 kb)

References

  1. 1.
    Turan A et al (2019) Association of neuraxial anesthesia with postoperative venous thromboembolism after noncardiac surgery: a propensity-matched analysis of ACS-NSQIP database. Anesth Analg 128(3):494–501CrossRefPubMedGoogle Scholar
  2. 2.
    Jaitly VK, Kumar C (2009) Continuous spinal anaesthesia for laparotomy. Curr Anaesth Crit Care 20:60–64CrossRefGoogle Scholar
  3. 3.
    Amin SM, Sadek S (2016) Continuous spinal anesthesia for elderly patients with cardiomyopathy undergoing lower abdominal surgeries. Egypt J Anaesth 32:535–540CrossRefGoogle Scholar
  4. 4.
    Gülçin Ö, Mensure K, Gonca T et al (2006) Original continuous spinal anaesthesia and analgesia in high-risk patients undergoing abdominal surgery. Indian J Surg 68:73–79Google Scholar
  5. 5.
    Michaloudis D et al (2000) Continuous spinal anaesthesia/analgesia for the perioperative management of high-risk patients. Eur J Anaesthesiol 17(4):239–247CrossRefPubMedGoogle Scholar
  6. 6.
    Parthasarathy S, Ravishankar M (2011) Continuous spinal anesthesia with epidural catheters: an experience in the periphery. Anesth Essays Res 5(2):187–189CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Desai V, Chan PH, Prentice HA, Zohman GL, Diekmann GR, Maletis GB (2018) Is anesthesia technique associated with a higher risk of mortality or complications within 90 days of surgery for geriatric patients with hip fractures? Clin Orthop Relat Res 476:1178–1188CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Poeran J et al (2015) Anesthesia type and perioperative outcome: open colectomies in the United States. J Surg Res 193(2):684–692CrossRefPubMedGoogle Scholar
  9. 9.
    Özbek U et al (2015) Patient safety and comparative effectiveness of anesthetic technique in open lung resections. Chest 148(3):722–730CrossRefPubMedGoogle Scholar
  10. 10.
    Memtsoudis SG et al (2013) Perioperative comparative effectiveness of anesthetic technique in orthopedic patients. Anesthesiology 118(5):1046–1058CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. March 2018. https://www.nice.org.uk/guidance/ng89/chapter/Recommendations. Accessed 5 Jan 2019
  12. 12.
    Gershman B et al (2018) The association of robot-assisted versus pure laparoscopic radical nephrectomy with perioperative outcomes and hospital costs. Eur Urol Focus.  https://doi.org/10.1016/j.euf.2018.10.004 CrossRefPubMedGoogle Scholar
  13. 13.
    Plante K et al (2017) Treatment trends, determinants, and survival of partial and radical nephrectomy for stage I renal cell carcinoma: results from the National Cancer Data Base, 2004–2013. Int Urol Nephrol 49(8):1375–1381CrossRefPubMedGoogle Scholar
  14. 14.
    Helwani MA et al (2015) Effects of regional versus general anesthesia on outcomes after total hip arthroplasty: a retrospective propensity-matched cohort study. J Bone Jt Surg Am 97(3):186–193CrossRefGoogle Scholar
  15. 15.
    Chu CC et al (2015) Propensity score-matched comparison of postoperative adverse outcomes between geriatric patients given a general or a neuraxial anesthetic for hip surgery: a population-based study. Anesthesiology 123(1):136–147CrossRefPubMedGoogle Scholar
  16. 16.
    Wongyingsinn M et al (2011) Intravenous lidocaine versus thoracic epidural analgesia: a randomized controlled trial in patients undergoing laparoscopic colorectal surgery using an enhanced recovery program. Reg Anesth Pain Med 36(3):241–248CrossRefPubMedGoogle Scholar
  17. 17.
    Wongyingsinn M et al (2012) Spinal analgesia for laparoscopic colonic resection using an enhanced recovery after surgery programme: better analgesia, but no benefits on postoperative recovery: a randomized controlled trial. Br J Anaesth 108(5):850–856CrossRefPubMedGoogle Scholar
  18. 18.
    Cummings KC et al (2018) Epidural compared with non-epidural analgesia and cardiopulmonary complications after colectomy: a retrospective cohort study of 20,880 patients using a national quality database. J Clin Anesth 47:12–18CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Lawson EH et al (2015) Comparison between clinical registry and medicare claims data on the classification of hospital quality of surgical care. Ann Surg 261(2):290–296CrossRefPubMedGoogle Scholar
  20. 20.
    Weingarten TN et al (2014) Hospitalization for partial nephrectomy was not associated with intrathecal opioid analgesia: retrospective analysis. Saudi J Anaesth 8(4):517–522CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Edwards MS et al (2011) Results of endovascular aortic aneurysm repair with general, regional, and local/monitored anesthesia care in the American College of Surgeons National Surgical Quality Improvement Program database. J Vasc Surg 54(5):1273–1282CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Neuman MD et al (2012) Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults. Anesthesiology 117(1):72–92CrossRefPubMedGoogle Scholar
  23. 23.
    Thurm M et al (2017) Spinal analgesia improves surgical outcome after open nephrectomy for renal cell carcinoma: a randomized controlled study. Scand J Urol 51(4):277–281CrossRefPubMedGoogle Scholar
  24. 24.
    Babazade R et al (2019) The cost-effectiveness of epidural, patient-controlled intravenous opioid analgesia, or transversus abdominis plane infiltration with liposomal bupivacaine for postoperative pain management. J Clin Anesth 53:56–63CrossRefPubMedGoogle Scholar
  25. 25.
    Wang M, Ng M, Bukavina L, Mahran A, Mishra K, Buzzy C, Garrels K, Ponsky L, Nguyen C (2019) Superfluous hospital expenditure associated with unnecessary renal cyst surveillance. Urol Pract.  https://doi.org/10.1097/UPJ.0000000000000067 CrossRefPubMedGoogle Scholar
  26. 26.
    Pugely AJ et al (2013) Differences in short-term complications between spinal and general anesthesia for primary total knee arthroplasty. J Bone Jt Surg Am 95(3):193–199CrossRefGoogle Scholar
  27. 27.
    Santaguida PL et al (2008) Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review. Can J Surg 51(6):428–436PubMedPubMedCentralGoogle Scholar
  28. 28.
    Chen LH, Hedegaard H, Warner M (2014) Drug-poisoning deaths involving opioid analgesics: United States, 1999–2011. NCHS Data Brief 166:1–8Google Scholar
  29. 29.
    Siegel RL, Miller K, Jemal A (2015) Cancer statistics, 2015. CA Cancer J Clin 65:5–29CrossRefPubMedGoogle Scholar
  30. 30.
    Schnell M, Currie J (2018) Addressing the opioid epidemic: is there a role for physician education? Am J Health Econ 4(3):383–410CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Shiloach M, Frencher S, Steeger JE Jr (2010) Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg 210:6–16CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Amr Mahran
    • 1
    • 2
  • Kirtishri Mishra
    • 2
  • Danly Omil-Lima
    • 2
  • Bissan Abboud
    • 2
  • Michael Wang
    • 1
    • 2
  • Jason Jankowski
    • 2
    • 3
  • Robert Abouassaly
    • 4
    • 5
  • Lee Ponsky
    • 2
    • 3
  • Irma Lengu
    • 6
  • Laura Bukavina
    • 2
    Email author
  1. 1.Case Western Reserve University School of MedicineClevelandUSA
  2. 2.Urology Institute, University Hospitals Cleveland Medical CenterCase Western Reserve University School of MedicineClevelandUSA
  3. 3.Case Comprehensive Cancer CenterCase Western Reserve University School of MedicineClevelandUSA
  4. 4.Glickman Urology and Kidney InstituteCleveland ClinicClevelandUSA
  5. 5.Louis Stokes Cleveland VA Medical CenterClevelandUSA
  6. 6.Metro Health Medical CenterClevelandUSA

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