SLR - May 2023 - Patricia Woo, DPM, PGY-1
Title: Does the Type of Anesthesia (regional vs. general) Represent an Independent Predictor for In-hospital Complications in Operatively Treated Malleolar Fractures? A Retrospective Analysis of 5262 PatientsReference: Canal, C., Kaserer, A., Sebastien Morax, A., et al. Does the Type of Anesthesia (regional vs. general) Represent an Independent Predictor for In-hospital Complications in Operatively Treated Malleolar Fractures? A Retrospective Analysis of 5262 Patients. Euro J Trauma Emerg Surg. Feb 2023; Doi: 10.1007/s00068-023-02235-7. Epub ahead of print.
Level of Evidence: Retrospective Cohort Study, Level III
Scientific Literature Review
Reviewed By: Patricia Woo, DPM, PGY-1
Residency Program: North Colorado Medical Center - Greeley, CO
Podiatric Relevance: Patients who sustain traumatic ankle fractures and undergo surgical intervention are often placed under general or regional anesthesia during their operations. Some patients may have comorbidities that require them to stay in the hospital following their procedures. It is important to determine the compounding factors, such as the type of anesthesia, that may predispose high risk patients to increased complications or longer hospitalization stays. As surgeons, it is important to understand these risks factors when discussing pre-operative planning with the anesthesia team. This study aimed to evaluate independent risk factors for complications during hospitalizations.
Methods: Patients included in the study were treated operatively for isolated fractures of the medial or lateral malleolus from 2005 – 2019 and were analyzed using a prospective national quality measurement database. This database includes information on both intraoperative and post-operative complications, categorizing them based on multiple factors including corresponding operation performed as well as complications listed by organ system. Patients were included based on their international classifications (ICD) and national procedure codes (CHOP) and both uni- and multivariate analysis was applied.
Results: There were 5262 patients included in the study with isolated fractures of the medial or lateral malleolus. Of these patients, 3003 (57%) had regional anesthesia and 2259 (43%) had general anesthesia. The average age of the patients was 49 years and 51% of the patients were male. Additionally, patients who underwent regional anesthesia were older (51 vs. 46 years), healthier (lower ASA-classification), and had less comorbidities than patients who underwent general anesthesia. Patients with regional anesthesia did have a statically significant shorter length of stay (6.7 vs. 7.8 days; p = < 0.001) compared with general anesthesia, however, there was no significant difference between mortality rate or overall complications. Significant predictors of complications included higher ASA class, age of 70+ years, longer pre-operative stay, and duration of surgery.
Conclusions: Based on the results of this study, anesthesia type was not an independent predictor for complications of operatively managed malleolar fractures. One major limitation of the study was that researchers were not able to obtain information regarding the patients after their discharge from the hospital. Therefore, it is unknown whether the anesthesia had delayed effects that were not accounted for. Further studies should be done to further evaluate the effects of anesthesia when using various anesthetic drugs or gases as well as with a longer follow up time.