General Versus Neuraxial Anesthesia for Appendectomy: A Multicenter International Study

Mohamad El Moheb, Kelsey Han, Kerry Breen, Majed El Hechi, Zhenyi Jia, Ava Mokhtari, Napaporn Kongkaewpaisan, Manasnun Kongwibulwut, Gabriel Rodriguez, Camilo Ortega, Huanlong Qin, Jun Yang, Renyuan Gao, Zhiguo Wang, Zhiguang Gao, Supparerk Prichayudh, Gwendolyn M van der Wilden, Stephanie Santin, Marcelo A F Ribeiro, Napakadol Noppakunsomboom, Joseph V Sakran, Bellal Joseph, Ramzi Alami, Haytham M A Kaafarani
World Journal of Surgery 2021, 45 (11): 3295-3301

BACKGROUND: In resource-limited countries, open appendectomy is still performed under general anesthesia (GA) or neuraxial anesthesia (NA). We sought to compare the postoperative outcomes of appendectomy under NA versus GA.

METHODS: We conducted a post hoc analysis of the International Patterns of Opioid Prescribing (iPOP) multicenter study. All patients ≥ 16 years-old who underwent an open appendectomy between October 2016 and March 2017 in one of the 14 participating hospitals were included. Patients were stratified into two groups: NA-defined as spinal or epidural-and GA. All-cause morbidity, hospital length of stay (LOS), and pain severity were assessed using univariate analysis followed by multivariable logistic regression adjusting for the following preoperative characteristics: age, gender, body mass index (BMI), smoking, history of opioid use, emergency status, and country.

RESULTS: A total of 655 patients were included, 353 of which were in the NA group and 302 in the GA group. The countries operating under NA were Colombia (39%), Thailand (31%), China (23%), and Brazil (7%). Overall, NA patients were younger (mean age (SD): 34.5 (14.4) vs. 40.7 (17.9), p-value < 0.001) and had a lower BMI (mean (SD): 23.5 (3.8) vs. 24.3 (5.2), p-value = 0.040) than GA patients. On multivariable analysis, NA was independently associated with less postoperative complications (OR, 95% CI: 0.30 [0.10-0.94]) and shorter hospital LOS (LOS > 3 days, OR, 95% CI: 0.47 [0.32-0.68]) compared to GA. There was no difference in postoperative pain severity between the two techniques.

CONCLUSIONS: Open appendectomy performed under NA is associated with improved outcomes compared to that performed under GA. Further randomized controlled studies should examine the safety and value of NA in lower abdominal surgery.

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