BACKGROUND: Hysterectomy is the most common major gynecologic operation in the United States. The procedure can be performed under either general anesthesia (GA) or a combination of general and neuraxial anesthesia (GNA). Findings from the orthopedic surgery literature suggest a beneficial effect of GNA on perioperative outcomes. However, key large-scale data for hysterectomy patients is still lacking.
METHODS: Patients undergoing inpatient hysterectomies were identified using the Premier Perspective claims-based database (2006-2014; n=459,508). The main effect of interest was the type of anesthesia used: GA, GNA, or unknown. Multilevel multivariable models measured associations between anesthetic type and outcomes: opioid utilization (in oral morphine equivalents), length and cost of hospital stay, need for blood transfusion, and respiratory / cardiac / renal / gastrointestinal / central nervous system / genitourinary / thromboembolic complications. Odds ratios (OR) and 95% confidence intervals (CI) are reported.
RESULTS: Overall, 82.7% (n=380,022) of patients received GA while 3.2% (n=14,864) received GNA with 14.06% (n=64,622) belonging to the unknown group. While differences in patient characteristics between anesthesia groups were relatively minor, higher GNA rates were seen in rural hospitals (8.1%), smaller hospitals (3.9%) and vaginal hysterectomies (4.7%). When adjusted for relevant covariates, GNA was associated with -30.7% (CI: -31.9;-29.4%) decreased opioid utilization when compared to GA patients; a further decrease of -9.9% (CI: -11.6;-8.1%) for cost of hospitalization was seen (both P<0.05). GNA was not associated with decreased risk of perioperative complications.
CONCLUSION: While the use of GNA is low among patients undergoing hysterectomies, its use is associated with a substantial decrease in opioid utilization and cost of hospitalization. However, this did not translate into lower risk for perioperative adverse outcomes. Given the high number of patients undergoing this procedure, additional research is needed to further assess the value of neuraxial anesthesia in this cohort.