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Regional Anesthesia, Time to Hospital Discharge, and In-Hospital Mortality: A Propensity Score Matched Analysis
  1. Catherine M. Bulka, MPH*,
  2. Matthew S. Shotwell, PhD,
  3. Rajnish K. Gupta, MD*,
  4. Warren S. Sandberg, MD, PhD*,,§ and
  5. Jesse M. Ehrenfeld, MD, MPH*,,§
  1. *Department of Anesthesiology, Vanderbilt University Medical Center, Vanderbilt University School of Medicine, Nashville, TN
  2. Departments of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
  3. Departments of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN
  4. §Departments of Surgery, Vanderbilt University School of Medicine, Nashville, TN
  1. Address correspondence to: Jesse Ehrenfeld, MD, MPH, Department of Anesthesiology, Vanderbilt University Medical Center, 1301 Medical Center Dr., Suite 4648 The Vanderbilt Clinic, Nashville, TN 37232(e-mail: Jesse.ehrenfeld{at}vanderbilt.edu).

Abstract

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 < 0.0001). A total of 86 cases died in the hospital after surgery; 7 were in the RA cohort and 79 were in the GA cohort. Receiving RA during surgery was associated with 64% lesser odds of dying in the hospital (odds ratio, 0.36; 95% confidence interval, 0.16–0.75), when adjusting for the number of postoperative days spent in the hospital.

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.

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Footnotes

  • The authors declare no conflict of interest.

    Supported by departmental funds.

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