Anesthesia technique, mortality, and length of stay after XXXX surgery.

@entity1 @entity173 @entity4282
IMPORTANCE: More than 300,000 @entity173 occur each year in the United States. Recent practice guidelines have advocated greater use of regional anesthesia for @entity173 surgery. OBJECTIVE: To test the association of regional (ie, @entity4282 ) anesthesia vs general anesthesia with 30-day mortality and hospital length of stay after @entity173 . DESIGN, SETTING, AND @entity1 : We conducted a matched retrospective cohort study involving @entity1 50 years or older who were undergoing surgery for @entity173 at general acute care hospitals in New York State between July 1, 2004, and December 31, 2011. Our main analysis was a near-far instrumental variable match that paired @entity1 who lived at different distances from hospitals that specialized in regional or general anesthesia. Supplementary analyses included a within-hospital match that paired @entity1 within the same hospital and an across-hospital match that paired @entity1 at different hospitals. EXPOSURES: Spinal or epidural anesthesia; general anesthesia. MAIN OUTCOMES AND MEASURES: Thirty-day mortality and hospital length of stay. Because the distribution of length of stay had long tails, we characterized this outcome using the Huber M estimate with Huber weights, a robust estimator similar to a trimmed mean. RESULTS: Of 56,729 @entity1 , 15,904 (28%) received regional anesthesia and 40,825 (72%) received general anesthesia. Overall, 3032 @entity1 (5.3%) died. The M estimate of the length of stay was 6.2 days (95% CI, 6.2 to 6.2). The near-far matched analysis showed no significant difference in 30-day mortality by anesthesia type among the 21,514 @entity1 included in this match: 583 of 10,757 matched @entity1 (5.4%) who lived near a regional anesthesia-specialized hospital died vs 629 of 10,757 matched @entity1 (5.8%) who lived near a general anesthesia-specialized hospital (instrumental variable estimate of risk difference, -1.1%; 95% CI, -2.8 to 0.5; P   =   .20). Supplementary analyses of within and across hospital @entity1 matches yielded mortality findings to be similar to the main analysis. In the near-far match, regional anesthesia was associated with a 0.6-day shorter length of stay than general anesthesia (95% CI, -0.8 to -0.4, P   <   .001). Supplementary analyses also showed regional anesthesia to be associated with shorter length of stay, although the observed association was smaller in magnitude than in the main analysis. CONCLUSIONS AND RELEVANCE: Among adults in acute care hospitals in New York State undergoing hip repair, the use of regional anesthesia compared with general anesthesia was not associated with lower 30-day mortality but was associated with a modestly shorter length of stay. These findings do not support a mortality benefit for regional anesthesia in this setting.
