ASSESSMENT OF PERIOPERATIVE OUTCOMES IN PATIENTS UNDERGOING MAJOR SURGERY: A COMPARATIVE ANALYSIS OF REGIONAL VS. GENERAL ANAESTHESIA
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Abstract
Major surgery poses significant challenges in perioperative management, where the choice between regional and general anesthesia can profoundly impact patient outcomes and healthcare costs. This study addresses the ongoing debate by examining the outcomes associated with regional versus general anesthesia in a diverse cohort of surgical patients. We conducted a retrospective cohort study involving 18,158 patients undergoing major hip surgery across hospitals in Maharashtra. The study aimed to evaluate the association of anesthesia type—regional versus general—with inpatient mortality, pulmonary complications, and cardiovascular outcomes. Utilizing hospital fixed-effects logistic regressions, we adjusted for various factors including surgical anatomy to assess the differential impact of anesthesia techniques. Among the patients studied, 5,254 (29%) received regional anesthesia. The overall in-hospital mortality rate was 2.4% (435 patients). Initial comparisons revealed no significant differences in unadjusted mortality rates or cardiovascular complications between regional and general anesthesia groups. However, patients receiving regional anesthesia experienced significantly fewer pulmonary complications (6.8% vs. 8.1%, P < 0.005). After adjusting for confounding factors, regional anesthesia was associated with lower odds of mortality (odds ratio: 0.710, 95% CI 0.541-0.932, P = 0.014) and pulmonary complications (odds ratio: 0.752, 95% CI 0.637-0.887, P < 0.0001) compared to general anesthesia. Subgroup analyses further highlighted these benefits, particularly among patients with specific fracture types such as intertrochanteric fractures. This comparative analysis underscores the potential advantages of regional anesthesia over general anesthesia in major surgery, particularly in reducing inpatient mortality and pulmonary complications. These findings contribute valuable insights into optimizing anesthesia practices and improving perioperative care for surgical patients.