Global anaesthesia practice using inguinal hernia surgery as a tracer condition: a secondary analysis of an international prospective cohort study

Abstract

Restoration of surgical capacity is essential to post-COVID-19 recovery. This study explored the use and safety of anaesthesia options for inguinal hernia surgery, a common tracer condition, to describe current global practice and highlight opportunities to build the capacity of health systems. This is a secondary analysis of an international prospective cohort study of consecutive patients who underwent elective inguinal hernia surgery. We used a consensus process to define generalisable outcomes to measure patient selection, utilisation of hospital capacity and peri-operative safety in patients who received locoregional, spinal or general anaesthesia for their surgery. In total, 16,554 patients from 83 countries were included. Locoregional anaesthesia was performed in 1536 (9.2%) of patients, compared with 9165 (55.4%) who had general and 55,853 (35.4%) who had spinal anaesthesia. Patient selection outcomes were comparable across anaesthesia groups. As a measure of hospital capacity, adjusted day-case rates were higher for locoregional anaesthesia (OR 6.62, 95%CI 5.13-8.54, p < 0.001) but not for spinal anaesthesia (OR 0.97, 95%CI 0.84-1.12, p = 0.68) compared with general anaesthesia. Complications were lower in patients who underwent locoregional anaesthesia (OR = 0.67, 95%CI 0.52-0.87, p = 0.001) but not for spinal anaesthesia (OR = 0.90, 95%CI 0.77-1.05, p = 0.167) compared with general anaesthesia after risk adjustment. This study has filled knowledge gaps of anaesthesia practice in common surgeries across the world. Locoregional and spinal anaesthesia could be adopted as safe options to increase surgical volume when there is limited access to general anaesthesia. After the COVID‐19 pandemic, it's important to get hospitals back to doing regular surgeries again. This study looked at the types of anaesthesia (medicine that helps patients not feel pain during surgery) used during a common operation called inguinal hernia surgery. The goal was to see how safe the different types are and how they are being used around the world. The study used information from another big study that followed patients from many countries who had planned hernia surgeries. The researchers looked at three types of anaesthesia: general anaesthesia (makes you sleep during surgery); spinal anaesthesia (numbs the lower part of your body); and locoregional anaesthesia (numbs just the area being operated on). The researchers compared how doctors chose which anaesthesia to use and if patients had any problems after surgery. The study looked at 16,554 patients from 83 countries: 9% had locoregional anaesthesia; 55% had general anaesthesia; and 35% had spinal anaesthesia. People who had locoregional anaesthesia were more likely to go home the same day. People who had locoregional anaesthesia also had fewer problems after surgery. Spinal anaesthesia didn't show big differences compared to general anaesthesia in those areas. This study helps us understand how anaesthesia is used for a common surgery around the world. It showed that locoregional and spinal anaesthesia can be safe choices, especially in places where general anaesthesia is harder to get. Using these types can help hospitals do more surgeries safely and quickly.