Feasibility of Umbilical Hernia Repair Under Local Anesthesia and Monitored Anesthesia Care at a Veteran Affairs Hospital.

Abstract

BACKGROUND:

Local anesthesia (LA) for open umbilical hernia tissue repair (OUHTR) is not widely utilized in academic centers in the United States. We hypothesize that LA for OUHTR is feasible in a veteran patient population.

METHODS:

From 2015 to 2019, 449 umbilical hernias were repaired at our institution utilizing a standardized technique in veteran patients. OUHTR was included in this analysis (n = 283). Since 2017, 18.7% (n = 53) UH were repaired under LA. We compared outcomes and operative times between general anesthesia and LA in patients undergoing OUHTR. Univariable and multivariable analyses were performed to determine significance.

RESULTS:

The entire cohort was composed of older (56.3 ± 12.1 years), White (75.5%), obese (body mass index [BMI] = 32.3 ± 4.6 kg/m2) men (98.0%). The average hernia size for the entire cohort was 2.42 ± 1.2 cm. The groups were similar in age and BMI. Patients with higher American Society of Anesthesiologists (ASA) (Odds ratio [OR] 3.1; 95% CI 1.5-6.8) and cardiovascular disease (OR 2.7; 95% CI 1.0-7.2) were more likely to receive LA. Recurrence (0.0% vs 6.0%; P = .9) and 30-day complications (6.0% vs 13%; P = .9) were similar between LA and GA after correcting for hernia size. Operating room times were reduced in the LA group (17.7 minutes; P < .05). None of the patients with LA required postanesthesia care unit for recovery. The patients who received LA reported being comfortable (78.9% of patients), with the worst reported pain being 2.4 ± 2.4 (out of a scale of 10), and 94.7% would elect to receive LA if they had another hernia repair.

CONCLUSION:

Patients who received LA had more cardiac disease and a higher ASA. Complications were similar between both groups. LA reduced operating room times. Patients were satisfied with LA.

• Authors: Lindsey Loss, Jennie Meier, Tri Phung, Javier Ordonez, Sergio Huerta
• Journal: The American surgeon (Am Surg) Vol. 88 Issue 2 Pg. 167-173 (Feb 2022) ISSN: 1555-9823 [Electronic] United States
• PMID: 34846213 (Publication Type: Journal Article)

Topics

• Analysis of Variance
• Anesthesia, General (statistics & numerical data)
• Anesthesia, Local (statistics & numerical data)
• Body Mass Index
• Feasibility Studies
• Female
• Hernia, Umbilical (surgery)
• Herniorrhaphy (methods, statistics & numerical data)
• Hospitals, Veterans
• Humans
• Male
• Middle Aged
• Monitoring, Intraoperative
• Operative Time
• Pain Measurement
• Postoperative Complications (epidemiology)
• Recurrence
• Retrospective Studies