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Using Local Anesthesia for Inguinal Hernia Repair Reduces Complications in Older Patients.

Publication ,  Journal Article
Balentine, CJ; Meier, J; Berger, M; Reisch, J; Cullum, M; Lee, SC; Skinner, CS; Brown, CJ
Published in: J Surg Res
February 2021

BACKGROUND: Inguinal hernia repair is the most common general surgery operation in the United States. Nearly 80% of inguinal hernia operations are performed under general anesthesia versus 15%-20% using local anesthesia, despite the absence of evidence for the superiority of the former. Although patients aged 65 y and older are expected to benefit from avoiding general anesthesia, this presumed benefit has not been adequately studied. We hypothesized that the benefits of local over general anesthesia for inguinal hernia repair would increase with age. MATERIALS AND METHODS: We analyzed 87,794 patients in the American College of Surgeons National Surgical Quality Improvement Project who had elective inguinal hernia repair under local or general anesthesia from 2014 to 2018, and we used propensity scores to adjust for known confounding. We compared postoperative complications, 30-day readmissions, and operative time for patients aged <55 y, 55-64 y, 65-74 y, and ≥75 y. RESULTS: Using local rather than general anesthesia was associated with a 0.6% reduction in postoperative complications in patients aged 75+ y (95% CI -0.11 to -1.13) but not in younger patients. Local anesthesia was associated with faster operative time (2.5 min - 4.7 min) in patients <75 y but not in patients aged 75+ y. Readmissions did not differ by anesthesia modality in any age group. Projected national cost savings for greater use of local anesthesia ranged from $9 million to $45 million annually. CONCLUSIONS: Surgeons should strongly consider using local anesthesia for inguinal hernia repair in older patients and in younger patients because it is associated with significantly reduced complications and substantial cost savings.

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Published In

J Surg Res

DOI

EISSN

1095-8673

Publication Date

February 2021

Volume

258

Start / End Page

64 / 72

Location

United States

Related Subject Headings

  • United States
  • Surgery
  • Retrospective Studies
  • Postoperative Complications
  • Patient Readmission
  • Operative Time
  • Middle Aged
  • Male
  • Humans
  • Herniorrhaphy
 

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Balentine, C. J., Meier, J., Berger, M., Reisch, J., Cullum, M., Lee, S. C., … Brown, C. J. (2021). Using Local Anesthesia for Inguinal Hernia Repair Reduces Complications in Older Patients. J Surg Res, 258, 64–72. https://doi.org/10.1016/j.jss.2020.08.054
Balentine, Courtney J., Jennie Meier, Miles Berger, Joan Reisch, Munro Cullum, Simon C. Lee, Celette Sugg Skinner, and Cynthia J. Brown. “Using Local Anesthesia for Inguinal Hernia Repair Reduces Complications in Older Patients.J Surg Res 258 (February 2021): 64–72. https://doi.org/10.1016/j.jss.2020.08.054.
Balentine CJ, Meier J, Berger M, Reisch J, Cullum M, Lee SC, et al. Using Local Anesthesia for Inguinal Hernia Repair Reduces Complications in Older Patients. J Surg Res. 2021 Feb;258:64–72.
Balentine, Courtney J., et al. “Using Local Anesthesia for Inguinal Hernia Repair Reduces Complications in Older Patients.J Surg Res, vol. 258, Feb. 2021, pp. 64–72. Pubmed, doi:10.1016/j.jss.2020.08.054.
Balentine CJ, Meier J, Berger M, Reisch J, Cullum M, Lee SC, Skinner CS, Brown CJ. Using Local Anesthesia for Inguinal Hernia Repair Reduces Complications in Older Patients. J Surg Res. 2021 Feb;258:64–72.
Journal cover image

Published In

J Surg Res

DOI

EISSN

1095-8673

Publication Date

February 2021

Volume

258

Start / End Page

64 / 72

Location

United States

Related Subject Headings

  • United States
  • Surgery
  • Retrospective Studies
  • Postoperative Complications
  • Patient Readmission
  • Operative Time
  • Middle Aged
  • Male
  • Humans
  • Herniorrhaphy