Abstract
Background Regional anesthesia (RA) may help to circumvent the well-documented risks associated
with general anesthesia, increase patient comfort and satisfaction, and mitigate costs.
This study aims to investigate the utility of RA in extremity reconstruction.
Methods The American College of Surgeons National Surgical Quality Improvement Program database
was queried for all cases of extremity reconstruction including muscle, myocutaneous,
or fasciocutaneous flaps from 2005 to 2016. Two groups were created based on anesthesia
technique, regional/epidural and general. Postoperative complications included reoperation,
readmission, and wound complications. Propensity score matching was utilized to control
for variation in sample size, significant comorbidities, and demographics in the analysis
of complications.
Results A total of 2,874 cases were identified with general anesthesia utilized in 2,820
cases and RA in the remaining 54. After propensity score matching, 53 cases were identified
in each group. In both unmatched and matched cohorts, there was no statistically significant
difference in the rates of reoperation, readmission, or wound complication rates.
In the matched cohort, mean operative time in the RA cohort was significantly shorter,
157.64 (±112.36) minutes compared with 293.06 minutes (±201.35 minutes) in the general
anesthesia group (p < 0.001). While no statistically significant difference was detected in mean length
of stay (LOS) between the two groups, the RA group experienced a clinically significant
shorter LOS of 5.77 days (±5.87 days) compared with 7.02 (±5.61) days in the general
anesthesia group (p = 0.269).
Conclusion RA may be a safe, reasonable alternative to general anesthesia in extremity reconstruction
without increase in postoperative complications. Additionally, RA use is associated
with a significant reduction in operative time, potentially leading to shorter and
safer procedures without compromising outcomes.
Keywords
anesthesia - extremity - microsurgery - reconstruction
