Department of Applied Health Sciences, School of Health Sciences, University of Birmingham, UK.
Anaesthesia. 2025 Nov;80(11):1343-1351. doi: 10.1111/anae.16686. Epub 2025 Sep 9.
Restoration of surgical capacity is essential to post-COVID-19 recovery. This study explored the use and safety of anaesthesia options for inguinal hernia surgery, a common tracer condition, to describe current global practice and highlight opportunities to build the capacity of health systems.
This is a secondary analysis of an international prospective cohort study of consecutive patients who underwent elective inguinal hernia surgery. We used a consensus process to define generalisable outcomes to measure patient selection, utilisation of hospital capacity and peri-operative safety in patients who received locoregional, spinal or general anaesthesia for their surgery.
In total, 16,554 patients from 83 countries were included. Locoregional anaesthesia was performed in 1536 (9.2%) of patients, compared with 9165 (55.4%) who had general and 55,853 (35.4%) who had spinal anaesthesia. Patient selection outcomes were comparable across anaesthesia groups. As a measure of hospital capacity, adjusted day-case rates were higher for locoregional anaesthesia (OR 6.62, 95%CI 5.13-8.54, p < 0.001) but not for spinal anaesthesia (OR 0.97, 95%CI 0.84-1.12, p = 0.68) compared with general anaesthesia. Complications were lower in patients who underwent locoregional anaesthesia (OR = 0.67, 95%CI 0.52-0.87, p = 0.001) but not for spinal anaesthesia (OR = 0.90, 95%CI 0.77-1.05, p = 0.167) compared with general anaesthesia after risk adjustment.
This study has filled knowledge gaps of anaesthesia practice in common surgeries across the world. Locoregional and spinal anaesthesia could be adopted as safe options to increase surgical volume when there is limited access to general anaesthesia.
恢复手术能力对于新冠疫情后的康复至关重要。本研究探讨了腹股沟疝手术（一种常见的追踪病症）麻醉方案的使用及安全性，以描述当前全球的实践情况，并突出卫生系统能力建设的机会。
这是一项对连续接受择期腹股沟疝手术患者进行的国际前瞻性队列研究的二次分析。我们采用了一个共识过程来定义可推广的结果，以衡量接受局部、脊髓或全身麻醉进行手术的患者的患者选择、医院容量利用和围手术期安全性。
总共纳入了来自83个国家的16554名患者。1536名（9.2%）患者接受了局部麻醉，相比之下，9165名（55.4%）接受了全身麻醉，5585名（35.4%）接受了脊髓麻醉。各麻醉组的患者选择结果具有可比性。作为衡量医院容量的指标，与全身麻醉相比，局部麻醉的调整日间手术率更高（OR 6.62，95%CI 5.13 - 8.54，p < 0.001），但脊髓麻醉并非如此（OR 0.97，95%CI 0.84 - 1.12，p = 0.68）。风险调整后，接受局部麻醉的患者并发症较低（OR = 0.67，95%CI 0.52 - 0.87，p = 0.001），但脊髓麻醉并非如此（OR = 0.90，95%CI 0.77 - 1.05，p = 0.167）与全身麻醉相比。
本研究填补了全球常见手术麻醉实践的知识空白。当全身麻醉难以获取时，局部和脊髓麻醉可作为安全选择以增加手术量。
