Using local rather than general anesthesia for inguinal hernia repair may significantly reduce complications for frail Veterans.

Journal Article (Journal Article)

BACKGROUND: Frailty predisposes patients to poor postoperative outcomes. We evaluated whether using local rather than general anesthesia for hernia repair could mitigate effects of frailty. METHODS: We used the Risk Analysis Index (RAI) to identify 8,038 frail patients in the 1998-2018 Veterans Affairs Surgical Quality Improvement Program database who underwent elective, open unilateral inguinal hernia repair under local or general anesthesia. Our outcome of interest was the incidence of postoperative complications. RESULTS: In total, 5,188 (65%) patients received general anesthesia and 2,850 (35%) received local. Local anesthesia was associated with a 48% reduction in complications (OR 0.52, 95%CI 0.38-0.72). Among the frailest patients (RAI≥70), predicted probability of a postoperative complication ranged from 22 to 33% with general anesthesia, compared to 13-21% with local. CONCLUSIONS: Local anesthesia was associated with a ∼50% reduction in postoperative complications in frail Veterans. Given the paucity of interventions for frail patients, there is an urgent need for a randomized trial comparing effects of anesthesia modality on postoperative complications in this vulnerable population.

Full Text

Duke Authors

Cited Authors

  • Meier, J; Berger, M; Hogan, T; Reisch, J; Zeh, H; Cullum, CM; Lee, SC; Skinner, CS; Brown, CJ; Balentine, CJ

Published Date

  • September 2021

Published In

Volume / Issue

  • 222 / 3

Start / End Page

  • 619 - 624

PubMed ID

  • 33504434

Pubmed Central ID

  • PMC8295403

Electronic International Standard Serial Number (EISSN)

  • 1879-1883

Digital Object Identifier (DOI)

  • 10.1016/j.amjsurg.2021.01.026


  • eng

Conference Location

  • United States