Anesthesia Type and Postoperative Outcomes for Patients Receiving Arthroscopic Rotator Cuff Repairs

Abstract

Background: As the indications for and the volume of arthroscopic rotator cuff repair increase, it is important to optimize perioperative care to minimize postoperative complications and health care costs. Purpose: We sought to investigate if the anesthesia type used affects the rate of postoperative complications in patients undergoing arthroscopic rotator cuff repairs. Methods: We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database to identify patients undergoing arthroscopic rotator cuff repair from 2014 to 2018. Patients were divided into 3 cohorts: general anesthesia, regional anesthesia, and combined general plus regional anesthesia. Bivariate and multivariate analyses with stepwise technique were performed on data related to patient demographics, smoking history, functional status, medical comorbidities (ie, bleeding disorders, chronic obstructive pulmonary disease, and dialysis), and postoperative outcomes within 30 days of discharge. To assess the independent risk factors for postoperative complications, demographics and medical comorbidities were included in the multivariate analyses for any variables that derived P values <.20. Results: Of 24,677 total patients undergoing arthroscopic rotator cuff repair, 15,661 (63.5%) had general anesthesia, 889 (3.6%) had regional anesthesia, and 8127 (32.9%) received combined general plus regional anesthesia. Patients who received general anesthesia rather than regional anesthesia were more frequently white (76.8% vs 74.8%, respectively) and had a medical history of hypertension (47.9% vs 41.8%, respectively), smoking (14.9% vs 12.4%, respectively), and chronic obstructive pulmonary disease (3.4% vs 1.6%, respectively). Compared with patients receiving general anesthesia, those receiving combined general plus regional were more likely to have higher American Society of Anesthesiologists class and a smoking history. Following adjustment, patients who underwent regional anesthesia had a decreased risk for postoperative admission compared with patients who had general anesthesia. Patients who underwent combined regional plus general anesthesia had decreased rates of wound complications and readmission compared with those who received general anesthesia. Conclusion: Among patients undergoing arthroscopic rotator cuff repair, this retrospective study found a significantly higher rate of respiratory and cardiac comorbidities with general anesthesia compared with regional anesthesia. When controlling for these confounders, the use of regional anesthesia was still associated with lower rates of postoperative readmission compared with the general and combined subgroups. Patients receiving combined general plus regional anesthesia had decreased rates of wound complications and readmittance compared with general anesthesia. These findings may influence anesthetic choice in minimizing postoperative complications for rotator cuff repairs.

Team Approach: Improving Orthopaedic Operating Room Efficiency

“…Regional anesthesia for orthopaedic procedures has been demonstrated to decrease narcotic consumption, nausea and vomiting, PACU length of stay, and hospital readmission rates 14-16 . However, when performed in the OR, this can extend OR time.…”

Wide-awake local anesthesia for open rotator cuff repair: A case report

“…The rotator cuff tear can be managed conservatively in most cases however surgical treatment is inevitable in persistent patients. According to the current literature while the outcomes of arthroscopic and open repair are most likely the same; open cuff repair is more cost-effective than arthroscopic repair [ [3] , [4] , [5] ]. Several anesthesia options are available for rotator cuff repair such as general, regional, and combined anesthesia.…”

“…Several anesthesia options are available for rotator cuff repair such as general, regional, and combined anesthesia. Anesthesia is associated with respiratory and cardiac comorbidities; therefore, the use of regional anesthesia is a good alternative [ 3 ].…”

“…The wide-awake Local Anesthesia No Tourniquet (WALANT) approach has been developed for numerous orthopedic surgeries, including upper extremity soft tissue surgery, ulnar fracture, olecranon fracture, and distal radius fracture, clavicle fracture, and ankle fracture. This wide-awake technique allows performing surgery in a comfortable, non-sedating, cooperative, tourniquet-free, safe, simple, and rapid manner [ [1] , [2] , [3] , [4] , [5] , [6] ]. To our knowledge, the WALANT technique has not previously been utilized to repair rotator cuff tears.…”