Propensity-matched analysis of general versus spinal anaesthesia for patients undergoing ankle fracture surgery

Category: Ankle Introduction/Purpose: The choice of anaesthesia is a modifiable risk factor in optimizing post-operative outcomes in hip and knee surgery, with decreased rates of transfusion, thromboembolic events, and infection with the use of spinal anaesthesia versus general anaesthesia. Regional anaesthesia has been evaluated with respect to its effect on early pain in patients undergoing ORIF of the ankle, but there is no data regarding complication rates. The purpose of this study was to compare operating time, length of stay, and rates of post-operative adverse events within 30-days in patients undergoing open reduction and internal fixation (ORIF) of the ankle using spinal vs. general anaesthesia. Methods: Adult patients who underwent ORIF of a closed ankle fracture from 2012 to 2016 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Patients who were operated on after admission from the ED are not included in the database. Operative time (skin to skin), length of stay, thirty-day adverse events, and unplanned readmissions were compared between patients who received general anaesthesia and those who received spinal anaesthesia. Propensity-adjustment with respect to known risk factors for complications and adjunctive regional block was used to match patients using a 1:4 ratio of spinal to general anaesthesia. Adverse events tracked included wound dehiscence, surgical site infection (superficial and deep), sepsis, venous thrombolic events, cardiac events, prolonged intubation, need for unplanned intubation, return to operating room, pneumonia, urinary tract infection, renal insufficiency, and re-admission within 30 days. Comparisons were performed using a propensity based multivariate analysis. Results: Of the 10,795 patients meeting inclusion criteria, 9,862 (91.4%) were treated with only general anaesthesia and 933 (8.6%) were treated with only spinal anaesthesia. Using propensity-scored matching, 822 patients in the spinal cohort were matched to 3,288 patients in the general cohort with similar baseline demographics (61.5% female, mean age 56.4). Procedure performed was similar in both cohorts (47% lateral malleolus ORIF, 34% bimalleolar ORIF, 10% trimalleolar ORIF, 8% medial malleolus ORIF, 1% posterior malleolus ORIF). Spinal anaesthesia was associated with increased length of stay (+0.5 days, 95% confidence interval (CI) 0.20-0.75, p<0.001) and increased mortality (0.6% vs 0.2%, OR: 4.02, 95% CI 1.15-14.1, p=0.03). Rates of overall complications (4.0% vs 4.2%) and readmissions (0.8% vs 0.7%) were similar and available in Table 1. Conclusion: General anaesthesia is predominantly used for fixation of ankle fractures. While spinal anaesthesia is associated with lower complication rates in hip and knee surgery, we found no advantage in patients undergoing ORIF of the ankle.

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Neuraxial anaesthesia is associated with improved outcomes and reduced postoperative complications in patients undergoing aseptic revision total hip arthroplasty

Hip International ◽

10.1177/1120700020975749 ◽

2020 ◽

pp. 112070002097574

Author(s):

Chapman Wei ◽

Alex Gu ◽

Arun Muthiah ◽

Safa C Fassihi ◽

Peter K Sculco ◽

...

Keyword(s):

Postoperative Complications ◽

Total Hip Arthroplasty ◽

Length Of Stay ◽

General Anaesthesia ◽

Hip Arthroplasty ◽

Postoperative Outcomes ◽

Complication Rates ◽

Total Hip ◽

Neuraxial Anaesthesia ◽

Extended Length

Background: As the incidence of primary total hip arthroplasty (THA) continues to increase, revision THA (rTHA) is becoming an increasingly common procedure. rTHA is widely regarded as a more challenging procedure, with higher complication rates and increased medical, social and economic burdens when compared to its primary counterpart. Given the complexity of rTHA and the projected increase in incidence of these procedures, patient optimisation is becoming of interest to improve outcomes. Anaesthetic choice has been extensively studied in primary THA as a modifiable risk factor for postoperative outcomes, showing favourable results for neuraxial anaesthesia compared to general anaesthesia. The impact of anaesthetic choice in rTHA has not been studied previously. Methods: A retrospective study was performed using the American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent rTHA between 2014 and 2017 were divided into 3 anaesthesia cohorts: general anaesthesia, neuraxial anaesthesia, and combined general-regional (neuraxial and/or peripheral nerve block) anaesthesia. Univariate and multivariate analyses were used to analyse patient characteristics and 30-day postoperative outcomes. Bonferroni correction was applied for post-hoc analysis. Results: In total, 5759 patients were identified. Of these, 3551 (61.7%) patients underwent general anaesthesia, 1513 (26.3%) patients underwent neuraxial anaesthesia, and 695 (12.1%) patients underwent combined general-regional anaesthesia. On multivariate analysis, neuraxial anaesthesia was associated with decreased odds for any-one complication (OR 0.635; p < 0.001), perioperative blood transfusion (OR 0.641; p < 0.001), and extended length of stay (OR 0.005; p = 0.005) compared to general anaesthesia. Conclusions: Relative to those receiving general anaesthesia, patients undergoing neuraxial anaesthesia are at decreased risk for postoperative complications, perioperative blood transfusions, and extended length of stay. Prospective controlled trials should be conducted to verify these findings.

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Surgery Delay Increases Length of Stay in Thoracolumbar Trauma

Neurosurgery ◽

10.1093/neuros/nyz310_446 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Lawrence Zeldin ◽

Sean N Neifert ◽

Robert J Rothrock ◽

Ian T McNeill ◽

Jonathan S Gal ◽

...

Keyword(s):

Length Of Stay ◽

Spinal Injury ◽

Specific Effect ◽

Spinal Trauma ◽

Spine Injury ◽

Complication Rates ◽

Improvement Program ◽

Delayed Surgery ◽

Significant Difference ◽

Surgery Timing

Abstract INTRODUCTION The ideal timing from admission of a thoracolumbar spinal trauma patient to the start of surgery at US trauma centers remains a hotly contested area of debate. The effect of surgical latency on patient outcomes in thoracolumbar trauma remains unclear. METHODS All 2013 to 2015 thoracolumbar spinal trauma cases from the American College of Surgeons Trauma Quality Improvement Program (TQIP) were analyzed. Patients with unsurvivable spine injury, polytraumas (serious injuries in more than one bodily region), and those discharged within 24 h were excluded. Patients were classified into 3 groups by surgery timing: less than 8 h (early, N = 1699), between 8 and 24 h (normal, N = 946), and over 24 h (delayed, N = 1601). Mortality, length of stay (LOS), and complication rates were compared between groups. Demographic variables and complication rates were compared. Multivariate logistic regression was utilized to determine the specific effect of surgery timing on outcomes. RESULTS Patients with earlier surgery presented with more severe spinal trauma (P < .0001). Patients in the normal surgical timing cohort were most likely to have altered mental status (4.97% vs 3.24%, P = .05), and less likely to suffer from UTI (4.97% vs 3.24%, P = .03). Patients in the delayed cohort were older (46.2 vs 43.7 yr, P = .0003), more likely to have a longer LOS (11.3 vs 10.6 d, P = .02), return to the ICU (2.94% vs 1.29%, P = .001), experience unplanned intubation (2.06% vs 1%, P = .01) and suffer from cardiac arrest (0.53% vs 1.19%, P = .04). Upon multivariate analysis, delayed surgery was an independent risk factor for prolonged LOS (OR: 1.21, 95% CI: 0.56-1.87, P = .0003). CONCLUSION Patients with earlier surgery possessed more severe spinal injury. When adjusting for demographics and severity, no significant difference is seen in mortality between the different surgery times; however, LOS is prolonged in patients with delayed surgery.

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Our experience of 200 cases of thyroid surgery under local anaesthesia versus general anaesthesia

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20173047 ◽

2017 ◽

Vol 3 (3) ◽

pp. 683

Author(s):

Sambhaji G. Chintale ◽

Vilas R. Kirdak ◽

Sonali P. Jatale ◽

Kaleem Shaikh

Keyword(s):

Length Of Stay ◽

General Anaesthesia ◽

Thyroid Surgery ◽

Local Anaesthesia ◽

Operating Time ◽

Length Of Hospital Stay ◽

Work Load ◽

Lesion Size ◽

Safe Alternative ◽

General Anaesthesia Group

Background: Local Anaesthesia is now being accepted universally as a safe alternative to general anaesthesia for thyroid surgery. This study was carried out to compare the outcomes of patients undergoing thyroid surgery under local and general anaesthesia. Methods: 200 patients who underwent thyroid surgery for benign and malignant diseases under local and general anaesthesia from March 2014 to march 2017 were analysed. Patient characteristics analysed were age, sex, pathology lesion size, operating time, length of stay, cost and post-operative complications. Results: Mean lesion sizes were 4.5 cms and 6.5 cms in local and general anaesthesia group respectively. Mean operating time was 50, 5 minutes and 75.5 minutes in local anaesthesia and general anaesthesia group respectively. Mean cost incurred was Rs. 2500 in local anaesthesia and Rs. 5500 in general anaesthesia group. Mean length of hospital stay was 40, 25 hours and 75.06 hours in local anaesthesia and general anaesthesia group respectively. Conclusions: Local anaesthesia is a safe alternative to general anaesthesia for patients undergoing thyroid surgery. Use of local anaesthesiahas resulted in a decreased length of stay, cost and means operating time, hence useful in a setup with limited anaesthesia time and increased work load.

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TP10.2.6Open appendicectomy under spinal anaesthesia – a valuable alternative during COVID-19

British Journal of Surgery ◽

10.1093/bjs/znab362.143 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Dinh Van Chi Mai ◽

Alex Sagar ◽

Oliver Claydon ◽

Ji Young Park ◽

Niteen Tapuria ◽

...

Keyword(s):

Patient Satisfaction ◽

General Anaesthesia ◽

Spinal Anaesthesia ◽

Stated Preference ◽

Case Series ◽

Standard Of Care ◽

District General Hospital ◽

Complication Rates ◽

Open Appendicectomy ◽

Surgical Department

Abstract Introduction Concerns relating to COVID-19 and general anaesthesia prompted our department to consider that open appendicectomy under spinal anaesthesia (SA) avoids aerosolisation from intubation and laparoscopy. Whilst common in developing nations, it is unusual in the United Kingdom (UK). We present the first UK case series and discuss its potential role during and after this pandemic. Methods We prospectively studied patients with appendicitis at a British district general hospital who were unsuitable for conservative management and consequently underwent open appendicectomy under SA. We also reviewed patient satisfaction after 30 days. This ran for 5 weeks from 25th March 2020 until the surgical department reverted to laparoscopic appendicectomy as the standard of care. Main outcomes were 30-day complication rates and patient satisfaction. Results None of the included seven patients were COVID positive. The majority (4/7) had complicated appendicitis. There were no major adverse (Clavien-Dindo grade III to V) post-operative events. Two patients suffered minor post-operative complications. Two experienced intra-operative pain. Mean operative time was 44 minutes. Median length of stay and return to activity was 1 and 14 days respectively. Although four stated preference in hindsight for general anaesthesia (GA), the majority (5/7) were satisfied with the operative experience under SA. Discussion Although contraindications, risk of pain, and specific complications may be limiting, our series demonstrates open appendicectomy under SA to be safe, feasible and acceptable in the UK. The technique could be a valuable contingency for COVID suspected cases and patients with high-risk respiratory disease.

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Hospital-acquired conditions: predictors and implications for outcomes following spine tumor resection

Journal of Neurosurgery Spine ◽

10.3171/2017.5.spine17439 ◽

2017 ◽

Vol 27 (6) ◽

pp. 717-722 ◽

Cited By ~ 1

Author(s):

Nikita Lakomkin ◽

Constantinos G. Hadjipanayis

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Adverse Events ◽

Multivariable Analysis ◽

Tumor Resection ◽

Improvement Program ◽

Spine Tumor ◽

Prolonged Length ◽

Hospital Acquired Conditions ◽

Hospital Acquired

OBJECTIVEHospital-acquired conditions (HACs) significantly compromise patient safety, and have been identified by the Centers for Medicare and Medicaid Services as events that will be associated with penalties for surgeons. The mitigation of HACs must be an important consideration during the postoperative management of patients undergoing spine tumor resection. The purpose of this study was to identify the risk factors for HACs and to characterize the relationship between HACs and other postoperative adverse events following spine tumor resection.METHODSThe 2008–2014 American College of Surgeons’ National Surgical Quality Improvement Program database was used to identify adult patients undergoing the resection of intramedullary, intradural extramedullary, and extradural spine lesions via current procedural terminology and ICD-9 codes. Demographic, comorbidity, and operative variables were evaluated via bivariate statistics before being incorporated into a multivariable logistic regression model to identify the independent risk factors for HACs. Associations between HACs and other postoperative events, including death, readmission, prolonged length of stay, and various complications were determined through multivariable analysis while controlling for other significant variables. The c-statistic was computed to evaluate the predictive capacity of the regression models.RESULTSOf the 2170 patients included in the study, 195 (9.0%) developed an HAC. Only 2 perioperative variables, functional dependency and high body mass index, were risk factors for developing HACs (area under the curve = 0.654). Hospital-acquired conditions were independent predictors of all examined outcomes and complications, including death (OR 2.26, 95% CI 1.24–4.11, p = 0.007), prolonged length of stay (OR 2.74, 95% CI 1.98–3.80, p < 0.001), and readmission (OR 9.16, 95% CI 6.27–13.37, p < 0.001). The areas under the curve for these models ranged from 0.750 to 0.917.CONCLUSIONSThe comorbidities assessed in this study were not strongly predictive of HACs. Other variables, including hospital-associated factors, may play a role in the development of these conditions. The presence of an HAC was found to be an independent risk factor for a variety of adverse events. These findings highlight the need for continued development of evidence-based protocols designed to reduce the incidence and severity of HACs.

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Early Adverse Events Following Pediatric Mandibular Advancement: Analysis of the ACS NSQIP-Pediatric Database

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211037852 ◽

2021 ◽

pp. 105566562110378

Author(s):

Kevin J. Carlson ◽

Suhas R. Bharadwaj ◽

William M. Dougherty ◽

Eric J. Dobratz

Keyword(s):

Adverse Event ◽

Adverse Events ◽

Statistical Significance ◽

Mandibular Advancement ◽

Complication Rates ◽

Improvement Program ◽

Diagnosis Codes ◽

American College Of Surgeons ◽

Postoperative Diagnosis ◽

Time Of Operation

Objective This study aims to assess early adverse events and patient factors associated with complications following mandible distraction osteogenesis (MDO). Materials and Methods The American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-Pediatric) database, years 2012 to 2019, was queried for patients undergoing mandible advancement via relevant Current Procedural Terminology and postoperative diagnosis codes. Thirty-day adverse events and co-morbidities are assessed. Results A total of 208 patients were identified with 17.3% (n = 36) experiencing an adverse event, reoperation (n = 14), and readmission (n = 11) being most common. Patients < 365 days old at the time of operation were more likely to experience an adverse event (26.1% vs 10.8%; P = .005). However, among patients less than 1 year of age, differences in the complication rates between patients ≤ 28 days and >28 days (30.2% vs 22.2%; P = .47) and those weighing ≤ 4 kg and >4 kg (31.7% vs 11.5%; P = .063) did not reach statistical significance. Conclusions Adverse events following mandible advancement are relatively common, though often minor. In our analysis of the NSQIP-Pediatric database, neonatal age ( ≤ 28 days) or weight ≤ 4 kg did not result in a statistically significant increase in complications among patients less than 1 year of age. Providers should consider early intervention in patients who may benefit from MDO.

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Most Readmissions Following Ankle Fracture Surgery Are Unrelated to Surgical Site Issues

Foot & Ankle Orthopaedics ◽

10.1177/2473011417695254 ◽

2017 ◽

Vol 2 (2) ◽

pp. 247301141769525 ◽

Cited By ~ 4

Author(s):

Michael C. Fu ◽

Kelsey Young ◽

Elizabeth Cody ◽

William W. Schairer ◽

Constantine A. Demetracopoulos ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Adverse Events ◽

Pulmonary Disease ◽

Ankle Fracture ◽

Open Fractures ◽

Improvement Program ◽

Multivariable Logistic Regression ◽

History Of ◽

Fracture Surgery

Background: Ankle fracture surgeries are generally safe and effective procedures; however, as quality-based reimbursement models are increasingly affected by postoperative readmission, we aimed to determine the causes and risk factors for readmission following ankle fracture surgery. Methods: Ankle fracture cases were identified from the prospectively collected American College of Surgeons National Surgical Quality Improvement Program from 2013 to 2014. Demographics, comorbidities, and fracture characteristics were collected. Rates of 30-day adverse events and readmissions were determined as well as the causes for readmission. Multivariable logistic regression analyses were performed to identify risk factors associated with having any adverse events and being readmitted within 30 days of surgery. Results: There were 5056 patients included; 167 (3.3%) were open fractures. The rate of any postoperative adverse event was 5.2%. There were 116 unplanned readmissions, with a readmission rate of 2.3%. Of the 116 unplanned readmissions, 49 (42.2%) were for reasons related to the surgery or surgical site, with the most common causes being deep surgical site/hardware infections (12.9%), superficial site infections (11.2%), and wound disruption (6.9%). Most readmissions were for reasons unrelated to the surgical site (51.7%), including cardiac disorders (8.6%), pulmonary disorders (7.8%), and neurological/psychiatric disorders (6.9%). The cause of readmission was unknown for 6% of readmissions. With multivariable logistic regression, the strongest risk factors for readmission were a history of pulmonary disease (odds ratio [OR], 2.29), American Society of Anesthesiologists (ASA) class ≥3 (OR, 2.28), and open fractures (OR, 2.04) (all P < .05). Conclusion: In this cohort of 5056 ankle fracture cases, 2.3% of patients were readmitted within 30 days, with at least 51.7% of all unplanned readmissions due to causes unrelated to the surgery or surgical site. Predictors of readmission included a history of pulmonary disease, higher ASA class, and open fractures. Based on these findings, we advocate close medical follow-up with nonorthopaedic providers after discharge for high-risk patients. Level of Evidence: Level III.

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Operative and nonoperative adverse events in the management of traumatic fractures of the thoracolumbar spine: a systematic review

Neurosurgical FOCUS ◽

10.3171/2014.4.focus1467 ◽

2014 ◽

Vol 37 (1) ◽

pp. E8 ◽

Cited By ~ 18

Author(s):

George M. Ghobrial ◽

Christopher M. Maulucci ◽

Mitchell Maltenfort ◽

Richard T. Dalyai ◽

Alexander R. Vaccaro ◽

...

Keyword(s):

Lumbar Spine ◽

Length Of Stay ◽

Adverse Events ◽

Nonoperative Management ◽

Thoracolumbar Spine ◽

Complication Rates ◽

Medline Search ◽

Significant Difference ◽

The Mean ◽

Nonoperative Group

Object Thoracolumbar spine injuries are commonly encountered in patients with trauma, accounting for almost 90% of all spinal fractures. Thoracolumbar burst fractures comprise a high percentage of these traumatic fractures (45%), and approximately half of the patients with this injury pattern are neurologically intact. However, a debate over complication rates associated with operative versus nonoperative management of various thoracolumbar fracture morphologies is ongoing, particularly concerning those patients presenting without a neurological deficit. Methods A MEDLINE search for pertinent literature published between 1966 and December 2013 was conducted by 2 authors (G.G. and R.D.), who used 2 broad search terms to maximize the initial pool of manuscripts for screening. These terms were “operative lumbar spine adverse events” and “nonoperative lumbar spine adverse events.” Results In an advanced MEDLINE search of the term “operative lumbar spine adverse events” on January 8, 2014, 1459 results were obtained. In a search of “nonoperative lumbar spine adverse events,” 150 results were obtained. After a review of all abstracts for relevance to traumatic thoracolumbar spinal injuries, 62 abstracts were reviewed for the “operative” group and 21 abstracts were reviewed for the “nonoperative” group. A total of 14 manuscripts that met inclusion criteria for the operative group and 5 manuscripts that met criteria for the nonoperative group were included. There were a total of 919 and 436 patients in the operative and nonoperative treatment groups, respectively. There were no statistically significant differences between the groups with respect to age, sex, and length of stay. The mean ages were 43.17 years in the operative and 34.68 years in the nonoperative groups. The majority of patients in both groups were Frankel Grade E (342 and 319 in operative and nonoperative groups, respectively). Among the studies that reported the data, the mean length of stay was 14 days in the operative group and 20.75 in the nonoperative group. The incidence of all complications in the operative and nonoperative groups was 300 (32.6%) and 21 (4.8%), respectively (p = 0.1065). There was no significant difference between the 2 groups with respect to the incidence of pulmonary, thromboembolic, cardiac, and gastrointestinal complications. However, the incidence of infections (pneumonia, urinary tract infection, wound infection, and sepsis) was significantly higher in the operative group (p = 0.000875). The incidence of instrumentation failure and need for revision surgery was 4.35% (40 of 919), a significant morbidity, and an event unique to the operative category (p = 0.00396). Conclusions Due to the limited number of high-quality studies, conclusions related to complication rates of operative and nonoperative management of thoracolumbar traumatic injuries cannot be definitively made. Further prospective, randomized studies of operative versus nonoperative management of thoracolumbar and lumbar spine trauma, with standardized definitions of complications and matched patient cohorts, will aid in properly defining the risk-benefit ratio of surgery for thoracolumbar spine fractures.

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“Enhanced Recovery” Protocol Compliance Influences Length of Stay: Resolving Barriers to Implementation

The American Surgeon ◽

10.1177/000313481808400622 ◽

2018 ◽

Vol 84 (6) ◽

pp. 801-807

Author(s):

Evon Zoog ◽

Remil Simon ◽

J. Daniel Stanley ◽

Richard Moore ◽

Shauna Lorenzo-Rivero ◽

...

Keyword(s):

Length Of Stay ◽

Enhanced Recovery ◽

Tertiary Care ◽

Bowel Function ◽

Colon Resection ◽

Complication Rates ◽

Improvement Program ◽

Barriers To Implementation ◽

Enhanced Recovery Protocol ◽

Protocol Compliance

Initial implementation and maintenance of an enhanced recovery protocol (ERP) is complex and has not been adequately described. The aim of this study was to investigate the efficacy of an ERP at a tertiary care academic institution. A secondary aim was to identify barriers to implementation and continued protocol compliance (PC) to further decrease length of stay (LOS). Patients undergoing colon resection from February 2, 2011 to December 19, 2014 were compared with patients that followed implementation of an ERP from August 10, 2015 to July 14, 2016. The primary endpoint was LOS. Secondary endpoints were PC, analgesia requirements, time to return of bowel function, and ileus. One hundred and seventy-seven historical controls were compared with 68 ERP patients. LOS was shorter in study patients (4.9 vs 7.1 days for open surgery; 3.3 vs 6.1 for laparoscopic surgery). Intraoperative IVF balance, morphine equivalents, and length of time to return of bowel function were significantly less in the ERP group (1445.89 ± 845.25 mL vs 3006.08 ± 1197.97 mL), (64.48 ± 114.49 vs 232.90 ± 541.47), (2.41 ± 1.32 days vs 3.82 ± 2.00 days). Rate of ileus was less in study patients (4.8 vs 14.7%). The readmission rate and 30-day National Surgical Quality Improvement Program complication rates were not significantly different. PC was negatively associated with LOS (r = -0.35, P = 0.0026). Similar to prior studies, this study demonstrates the efficacy of an ERP. Increased PC is associated with decreased LOS, thus providing further evidence that ERPs should be the standard of care. Scheduled interdisciplinary meetings to discuss patient outcomes and methods to increase PC can help further improve efficacy of ERPs.

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Risk Evaluation of General Anesthesia in Pediatric Skin Surgeries: A Retrospective Cohort Study in Saudi Arabia

Asploro Journal of Biomedical and Clinical Case Reports ◽

10.36502/2019/asjbccr.6170 ◽

2019 ◽

Vol 2 (3) ◽

pp. 106-114

Author(s):

Alhabeeb BM ◽

Alharthi AA ◽

Nasser Alhazmi AM ◽

Alobaid OA ◽

Mostafa Al‑Habib NI ◽

...

Keyword(s):

Cohort Study ◽

Adverse Events ◽

General Anaesthesia ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Pediatric Population ◽

Modern Technology ◽

P Value ◽

Complication Rates ◽

Invasive Procedures

Background: Use of general anaesthesia in outpatient invasive procedures has increased, especially in the field of dermatology. Being uncooperative, children often require general anaesthesia. Especially since surgical skin operations are painful and lengthy, dictating the use of general anaesthesia. Aim: The purpose of this study was to evaluate the safety, significant adverse events, and the complication rates related to general anaesthesia, when used among pediatric population underwent skin surgeries. Methods: We conducted a retrospective cohort study in the form of randomly selected patient chart review, with a surgical code in the array of 8,539–16,782 for 2 years. We reviewed registers to document any unexpected admissions, adverse events or complications. Surgical outcomes and anaesthesia complications were reviewed by three anaesthesia consultants. We conducted Inter-rater reliability test analysis and per cent agreement to determine the level of agreement between raters. Results: A total of 211 procedures were reported for 211 patients with 19 diagnoses. No adverse events related to anesthesia were recognized in any of those selected patients, apart from minor complications noticed in twelve patients (P value<0.03). Kappa value range between 0.78-1.00 (95% CI, 0.46809 to 1.00). Conclusion: In case of proper deploying of staff experience, appropriateness of choice of surgical procedure, patient selection, and modern technology as non-dependent confounding variables. Pediatric-trained anesthesiologists can safely use general anaesthesia in dermatological invasive procedures without significant complications.

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