Regional Anesthesia, Time to Hospital Discharge, and In-Hospital Mortality

[wtbcrna, MSN, DNP, CRNA]

[h=4]"Abstract[/h]

Background and Objectives: The anesthetic technique used during surgery can affect postoperative length of stay and outcomes, even after controlling for other clinically important factors. This study evaluated the impact of regional anesthesia (RA) compared with general anesthesia (GA) on the amount of time between leaving the operating room and hospital discharge and the odds of in-hospital mortality.

Methods: Surgical patients admitted after surgery, who received RA, were matched to patients who received GA by propensity score in a 1:4 ratio. We measured the association between anesthetic technique and time to hospital discharge using Kaplan-Meier methods. In-hospital mortality was analyzed using a generalized estimating equation logistic regression model.

Results: A total of 5870 inpatient surgical cases were analyzed; 1174 cases received RA and 4696 cases received GA. The median time to hospital discharge among patients who received RA was 67.6 hours compared with 71.9 hours among patients who received GA (P

Conclusions: The study data provide evidence that median time to discharge is shorter when RA is used instead of GA, controlling for other clinically important factors. Additionally, RA use during surgery was associated with a decrease in in-hospital mortality. When an appropriate option, RA may facilitate faster hospital discharge and improve patient outcomes."

Copyright © 2014 by American Society of Regional Anesthesia and Pain Medicine.

http://journals.lww.com/rapm/Abstract/onlinefirst/Regional_Anesthesia,_Time_to_Hospital_Discharge,.99596.aspx

[subee, MSN, CRNA]

This doesn't say much to me. Big difference in discharge time between spinals and axillary blocks.

[wtbcrna, MSN, DNP, CRNA]

This doesn't say much to me. Big difference in discharge time between spinals and axillary blocks.

There was a 64% less chance of dying in the RA group versus the GA group. That alone should make this study worthwhile enough to see if these results can be replicated.

[subee, MSN, CRNA]

Mortality difference I can believe. In the past worked with a group that just didn't give GA unless the type of surgery demanded it. Then I moved to another group that didn't want to take the time for regionals. There was a world of difference in complications. For me, it never made sense to anesthetize any part of the body that didn't need it.

[jwk]

I think I'd be concerned about being at ANY hospital where 1.5% of the patients died in the immediate post-op period.

[BCRNA]

Interesting article, but there are way to many potentially confounding variables that cant be controlled for statistically. The design they used can not prove cause and effect, only association. The 1.5% mortality would not be surprising at a level one trauma center, or a high acuity hospital. The patients are more likely to not recover.

There was a 64% less "odds" of dying, not liklihood. Those are two completely different terms. Converting the odds to "liklihood" would make it closer to 5%. Odds are difficult to interpret, and are often reported because it has a much larger number than liklihood ratios, makes it seem more important than it is. I think the article deserves more research to explore the findings.

Honestly, you could argue a difference of just four hours when both groups are almost 70 hours is not clinically significant, even if it is statistically. Its almost a 5 percent difference. Where I work we would have to hire a crna to do the blicks to prevent delays in surgery, plus most of our patients would demand to be unconscious. They would get a TIVA to induce general anesthesia anyway. Most patients would refuse a true regional. Thats my personal experience anyway.