Anesthesia Type and Short-Term Outcomes in Open Treatment of Hand Fractures

The hand is one of the most commonly fractured parts of the body. Many of these injuries are treated operatively. This study compares short-term outcomes between general anesthesia and other forms of anesthesia in the open treatment of hand fractures.

Procedures related to the open treatment of carpal, metacarpal, and phalangeal fractures from the years 2005-2017 were queried from the National Surgical Quality Improvement Program (NSQIP) database. Outcome measures included 30-day reoperation rate, length of stay (LOS), minor complications, and major complications. Chi-squared tests were used to identify significant demographics and comorbidities. Significant variables were included in a logistic regression model.

A total of 5,907 patients were included, of which 4,547 (77%) received general anesthesia, and 1,360 (23%) received local anesthesia, regional anesthesia, sedation, or monitored anesthesia care. Patients treated with general anesthesia were younger and more likely to be male. Operative time was longer with general anesthesia (65.0 vs. 59.8minutes, P<0.01). Anesthesia technique had no statistically significant association with thirty-day rate of reoperation, minor complications, or major complications (P=0.32, 0.91, and 0.07, respectively). General anesthesia had greater odds for LOS exceeding the 75th percentile (OR 2.05, P<0.01).

In the open treatment of hand fractures, short-term complication rates are similar between general anesthesia and other forms of anesthesia, but extended LOS is more likely with general anesthesia. When practical, surgeons can consider local anesthesia, regional anesthesia, sedation, and monitored anesthesia as reasonably safe alternatives to general anesthesia.