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J Chest Surg

Published online May 11, 2022

Copyright © Journal of Chest Surgery.

Utilization of Supplemental Regional Anesthesia in Lobectomy for Lung Cancer in the United States: A Retrospective Study

Yahya Alwatari , M.D., Vignesh Vudatha , M.D., Daniel Scheese , M.D., Salem Rustom , B.S., Dawit Ayalew , M.D., Athanasios E. Sevdalis , M.D., Walker Julliard , M.D., Rachit D. Shah , M.D.

Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA

Correspondence to:Yahya Alwatari
Tel 1-804-418-5858
E-mail yahya.alwatari@vcuhealth.org
ORCID
https://orcid.org/0000-0002-0219-3251

Received: December 27, 2021; Revised: February 25, 2022; Accepted: April 10, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Pulmonary lobectomy is the standard of care for the treatment of early- stage non-small cell lung cancer. This study investigated the rate of utilization of supplemental anesthesia in patients undergoing video-assisted thoracoscopic surgery (VATS) or open lobectomy using a national database and assessed the effect of regional block (RB) on postoperative outcomes.
Methods: Patients who underwent lobectomy for lung cancer between 2014?2019 were identified in the American College of Surgeons National Surgical Quality Improvement Program. The patients’ primary mode of anesthesia and supplemental anesthesia were recorded. Preoperative characteristics and postoperative outcomes were compared between 2 surgical groups: those who underwent general anesthesia (GA) alone versus GA with RB. Multivariable regression analyses were performed on the outcomes of interest.
Results: In total, 13,578 patients met the study criteria, with 87% undergoing GA and the remaining 13% receiving GA and RB. The use of neuraxial anesthesia decreased over the years, while RB use increased up to 20% in 2019. Age, body mass index, and preoperative comorbidities were comparable between groups. Patients who underwent VATS were more likely to receive RB than those who underwent thoracotomy. RB was most often utilized by thoracic surgeons. An adjusted analysis showed that RB use was associated with shorter hospital stays and a reduced likelihood of prolonged length of stay, but a higher rate of surgical site infections (SSIs).
Conclusion: In a large surgical database, there was underutilization of supplemental anesthesia in patients undergoing lobectomy for lung cancer. RB utilization was associated with a shorter length of hospital stay and an increase in SSI incidence.

Keywords: Lobectomy, Anesthesia, National Surgical Quality Improvement Program, Outcomes

Article

ahead

J Chest Surg

Published online May 11, 2022

Copyright © Journal of Chest Surgery.

Utilization of Supplemental Regional Anesthesia in Lobectomy for Lung Cancer in the United States: A Retrospective Study

Yahya Alwatari , M.D., Vignesh Vudatha , M.D., Daniel Scheese , M.D., Salem Rustom , B.S., Dawit Ayalew , M.D., Athanasios E. Sevdalis , M.D., Walker Julliard , M.D., Rachit D. Shah , M.D.

Department of Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA

Correspondence to:Yahya Alwatari
Tel 1-804-418-5858
E-mail yahya.alwatari@vcuhealth.org
ORCID
https://orcid.org/0000-0002-0219-3251

Received: December 27, 2021; Revised: February 25, 2022; Accepted: April 10, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Pulmonary lobectomy is the standard of care for the treatment of early- stage non-small cell lung cancer. This study investigated the rate of utilization of supplemental anesthesia in patients undergoing video-assisted thoracoscopic surgery (VATS) or open lobectomy using a national database and assessed the effect of regional block (RB) on postoperative outcomes.
Methods: Patients who underwent lobectomy for lung cancer between 2014?2019 were identified in the American College of Surgeons National Surgical Quality Improvement Program. The patients’ primary mode of anesthesia and supplemental anesthesia were recorded. Preoperative characteristics and postoperative outcomes were compared between 2 surgical groups: those who underwent general anesthesia (GA) alone versus GA with RB. Multivariable regression analyses were performed on the outcomes of interest.
Results: In total, 13,578 patients met the study criteria, with 87% undergoing GA and the remaining 13% receiving GA and RB. The use of neuraxial anesthesia decreased over the years, while RB use increased up to 20% in 2019. Age, body mass index, and preoperative comorbidities were comparable between groups. Patients who underwent VATS were more likely to receive RB than those who underwent thoracotomy. RB was most often utilized by thoracic surgeons. An adjusted analysis showed that RB use was associated with shorter hospital stays and a reduced likelihood of prolonged length of stay, but a higher rate of surgical site infections (SSIs).
Conclusion: In a large surgical database, there was underutilization of supplemental anesthesia in patients undergoing lobectomy for lung cancer. RB utilization was associated with a shorter length of hospital stay and an increase in SSI incidence.

Keywords: Lobectomy, Anesthesia, National Surgical Quality Improvement Program, Outcomes

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