General Versus Neuraxial Anesthesia for Appendectomy: A Multicenter International Study

Abstract

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 C 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.

Incidence and predictors of perioperative mortality in a low-resource country, Ethiopia: a prospective follow-up study

“…This finding is consistent with a study by Oussama et al 43. The best explanation might be that patients who receive regional anaesthesia will ambulate early to reduce the risk of thromboembolism, which might improve surgical outcomes and affect postoperative mortality 44. This study shows that a SpO2 level of less than 95% is associated with an increased risk of death after surgery.…”

“… 43 The best explanation might be that patients who receive regional anaesthesia will ambulate early to reduce the risk of thromboembolism, which might improve surgical outcomes and affect postoperative mortality. 44 This study shows that a SpO2 level of less than 95% is associated with an increased risk of death after surgery. The reason might be that patients with poor preoperative SpO2 have severe disease processes and require postoperative mechanical ventilation, negatively impacting postoperative mortality.…”

Invited Commentary: Neuraxial Anaesthesia for Appendectomy: Another Tool in the Toolbox

“…In this number of World Journal of Surgery, the use of Neuraxial Anaesthesia (NA, spinal, or epidural anaesthesia) for appendectomy is discussed and compared to the use of general anaesthesia (GA) [1]. The study material originates from an earlier multicentre study ''Opioids After Surgery in the United States Versus the Rest of the World: The International Patterns of Opioid Prescribing (iPOP) Multicenter Study'' published in 2020 in Annals of Surgery [2].…”