Choice of Anesthesia and Risk of Reoperation for Recurrence in
Choice of Anesthesia and Risk of Reoperation for Recurrence in
Objective: To analyze the relative risk of reoperation for recurrence using 3 anesthetic alternatives, general anesthesia (GA), regional (spinal-, epidural-) anesthesia (RA), and local anesthesia (LA), and to study time trends for various anesthetic and operative methods, as well as other risk factors regarding reoperation for recurrence.
Background: The method of anesthesia used for hernia repair is generally assumed not to affect the long-term outcome. The few studies on the topic have rendered conflicting results.
Methods: Data from the Swedish Hernia Register was used. Relative risk was first estimated using univariate analysis for assumed risk variables and then selecting variables with the highest or lowest univariate risk for multivariate analysis.
Results: From 1992 through 2001, 59,823 hernia repairs were recorded. Despite the fact that univariate analysis showed a somewhat lower risk for reoperation in the LA group, the multivariate analysis showed that LA was associated with a significantly increased risk for reoperation in primary but not in recurrent hernia repair. The Lichtenstein technique carried a significantly lower reoperation risk than any other method of operation.
Conclusions: LA was associated with a higher risk of reoperation for recurrence after primary hernia repair. The use of mesh techniques has increased considerably, and among these the Lichtenstein repair was associated with a significantly lower risk for reoperation than any other repair.
LA for groin hernia repair was first proposed by Cushing on the basis of a study initiated by Halsted more than 100 years ago. Despite the great renown of its first advocates the technique has not become generally accepted. Admittedly, LA is considered the anesthetic method of choice in specialized hernia centers. In general surgical practice, however, LA is only used in 5 to 8% of the patients. This is rather surprising because recent studies, retrospective, prospective, as well as randomized, all bear witness to its advantages over RA and GA. Among the reported advantages are simplicity, safety, extended postoperative analgesia, early mobilization without postanesthesia side effects, and low cost.
The long-term outcome of hernia repair is generally assumed not to be affected by method of anesthesia used. However, the evidence on which this assumption is based is far from convincing. The few studies on the topic have rendered conflicting results. Moreover, the information from randomized trials is limited since follow-up periods are relatively short.
The Swedish Hernia Register (SHR) today covers more than 80% of all Swedish surgical units where hernia surgery is performed. By the 31st of December 2001 almost 60,000 hernia repairs had been prospectively recorded, according to a protocol. All repairs are followed in life-table fashion until reoperation in the same groin or until death of patient. With such large numbers of data, it is possible to study time trends for anesthetic methods and repair techniques. Furthermore, multivariate analysis of risk for reoperation associated with alternatives in anesthesia and surgery may also be undertaken with appropriate adjustment for possible confounding factors.
In this investigation SHR data was used to estimate the relative risk (RR) of reoperation for recurrence with the 3 anesthetic alternatives. We also studied time trends in the use of various anesthetic and operative methods, as well as other risk factors for recurrence.
Objective: To analyze the relative risk of reoperation for recurrence using 3 anesthetic alternatives, general anesthesia (GA), regional (spinal-, epidural-) anesthesia (RA), and local anesthesia (LA), and to study time trends for various anesthetic and operative methods, as well as other risk factors regarding reoperation for recurrence.
Background: The method of anesthesia used for hernia repair is generally assumed not to affect the long-term outcome. The few studies on the topic have rendered conflicting results.
Methods: Data from the Swedish Hernia Register was used. Relative risk was first estimated using univariate analysis for assumed risk variables and then selecting variables with the highest or lowest univariate risk for multivariate analysis.
Results: From 1992 through 2001, 59,823 hernia repairs were recorded. Despite the fact that univariate analysis showed a somewhat lower risk for reoperation in the LA group, the multivariate analysis showed that LA was associated with a significantly increased risk for reoperation in primary but not in recurrent hernia repair. The Lichtenstein technique carried a significantly lower reoperation risk than any other method of operation.
Conclusions: LA was associated with a higher risk of reoperation for recurrence after primary hernia repair. The use of mesh techniques has increased considerably, and among these the Lichtenstein repair was associated with a significantly lower risk for reoperation than any other repair.
LA for groin hernia repair was first proposed by Cushing on the basis of a study initiated by Halsted more than 100 years ago. Despite the great renown of its first advocates the technique has not become generally accepted. Admittedly, LA is considered the anesthetic method of choice in specialized hernia centers. In general surgical practice, however, LA is only used in 5 to 8% of the patients. This is rather surprising because recent studies, retrospective, prospective, as well as randomized, all bear witness to its advantages over RA and GA. Among the reported advantages are simplicity, safety, extended postoperative analgesia, early mobilization without postanesthesia side effects, and low cost.
The long-term outcome of hernia repair is generally assumed not to be affected by method of anesthesia used. However, the evidence on which this assumption is based is far from convincing. The few studies on the topic have rendered conflicting results. Moreover, the information from randomized trials is limited since follow-up periods are relatively short.
The Swedish Hernia Register (SHR) today covers more than 80% of all Swedish surgical units where hernia surgery is performed. By the 31st of December 2001 almost 60,000 hernia repairs had been prospectively recorded, according to a protocol. All repairs are followed in life-table fashion until reoperation in the same groin or until death of patient. With such large numbers of data, it is possible to study time trends for anesthetic methods and repair techniques. Furthermore, multivariate analysis of risk for reoperation associated with alternatives in anesthesia and surgery may also be undertaken with appropriate adjustment for possible confounding factors.
In this investigation SHR data was used to estimate the relative risk (RR) of reoperation for recurrence with the 3 anesthetic alternatives. We also studied time trends in the use of various anesthetic and operative methods, as well as other risk factors for recurrence.
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