Foot and Ankle Surgery Postoperative Complications with Regional vs General Anesthesia

Abstract

Category: Trauma; Other Introduction/Purpose: Regional anesthesia has been increasingly used within orthopaedic surgery. It has been found to decrease opioid use and consumption and has been associated with decreased blood loss and clot formation in some lower extremity surgeries – specifically hip and knee arthroplasty surgery. General anesthesia is not without risks including malignant hyperthermia, laryngeal edema, vocal cord trauma, and delirium. This has led to increased utilization of regional anesthesia in foot and ankle surgery. However, there is a paucity of research that compares the postoperative outcomes in patients treated with regional compared to general anesthesia in these surgeries. We hypothesize the use of regional anesthesia in foot and ankle surgery leads to fewer short-term postoperative complications compared to general anesthesia. Methods: The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was queried from 2006-2018 to identify patients undergoing foot and ankle surgery. Current Procedural Terminology (CPT) codes for all foot and ankle surgery were utilized to determine which participants to include in the analysis. The cohort was divided into patients who received regional anesthesia versus those who received general anesthesia, and comparisons were made on demographic characteristics, and comorbidities, using chi-squared and t-test analyses. Multivariate logistic regressions were performed to identify whether lack of regional anesthesia was an independent risk factor for infection, minor postoperative complications, and major postoperative complications. Major postoperative complications included any complication that had a long-term effect on someone’s life or led to reoperation, while minor postoperative complications included any event that needed medical intervention but did not impact a person’s health long-term. Results: Using the ACS-NSQIP database and CPT codes, there were 12,764 participants for regional anesthesia and 73,481 participants who had general anesthesia. Utilizing logistic regression, this study found that the absence of regional anesthesia was independently associated with an increased risk for minor complications in foot and ankle surgery (Odds Ratio (OR) 1.34, 95% Confidence Interval (CI) [1.25-1.44], p=0.00). The absence of regional anesthesia was not associated with increased risk of major complications in foot and ankle surgery (OR 1.04, CI [0.96-1.12], p=0.32). Patients who received regional anesthesia were older and had more comorbidities than those without regional anesthesia used which may be a reason for the findings for major complications. Conclusion: Regional anesthesia independently reduced the risk of minor postoperative complications up to 30-days following foot and ankle surgery in this study. Patients undergoing foot and ankle surgery may benefit from augmenting their anesthetic plan with regional anesthesia.