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

Area of Science:

• Anesthesiology
• Surgical Outcomes
• Public Health

Background:

• Open appendectomy is a common surgical procedure, particularly in resource-limited settings.
• General anesthesia (GA) and neuraxial anesthesia (NA) are the primary anesthetic techniques employed.
• Comparative data on postoperative outcomes between NA and GA for appendectomy are limited.

Purpose of the Study:

• To compare the postoperative outcomes of open appendectomy performed under neuraxial anesthesia (NA) versus general anesthesia (GA).
• To evaluate the association of NA with postoperative complications, hospital length of stay (LOS), and pain severity.

Main Methods:

• A post hoc analysis of the International Patterns of Opioid Prescribing (iPOP) multicenter study.
• Included 655 patients aged ≥16 years undergoing open appendectomy.
• Stratified patients into NA (spinal or epidural) and GA groups; analyzed all-cause morbidity, LOS, and pain severity using multivariable logistic regression.

Main Results:

• Neuraxial anesthesia (NA) was associated with significantly fewer postoperative complications (OR, 0.30 [0.10-0.94]).
• NA group experienced a shorter hospital length of stay (LOS > 3 days, OR, 0.47 [0.32-0.68]) compared to GA.
• No significant difference in postoperative pain severity was observed between NA and GA groups.

Conclusions:

• Open appendectomy under NA demonstrates improved postoperative outcomes, including reduced complications and shorter hospital stays, compared to GA.
• Further randomized controlled trials are warranted to confirm the safety and efficacy of NA in lower abdominal surgeries.