Publication:
General Versus Neuraxial Anesthesia for Appendectomy: A Multicenter International Study

Issued Date

2021-11-01

Resource Type

Article

ISSN

14322323
03642313

DOI

10.1007/s00268-021-05978-9

Other identifier(s)

2-s2.0-85100549043

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

World Journal of Surgery. Vol.45, No.11 (2021), 3295-3301

Suggested Citation

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 General Versus Neuraxial Anesthesia for Appendectomy: A Multicenter International Study. World Journal of Surgery. Vol.45, No.11 (2021), 3295-3301. doi:10.1007/s00268-021-05978-9 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/77755

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Title

General Versus Neuraxial Anesthesia for Appendectomy: A Multicenter International Study

Author(s)

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

Other Contributor(s)

Siriraj Hospital
 Tongji University School of Medicine
 Shanghai Sixth People's Hospital
 Shanghai Dongfang Hospital
 American University of Beirut
 Massachusetts General Hospital
 King Chulalongkorn Memorial Hospital
 University of Arizona College of Medicine – Tucson
 Leids Universitair Medisch Centrum
 Faculty of Medicine, Thammasat University
 Changzheng Hospital
 Universidade de São Paulo
 Johns Hopkins University
 Hospital Brasil Rede D´Or
 Hospital Departamental Villavicencio

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 ≥ 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.

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/77755

Collections

Scopus 2021