Discharge one hour sooner: Comparing post-operative metrics between spinal and general anesthetics among male infants undergoing circumcision.

INTRODUCTION AND BACKGROUND: The aim of this study is to determine if spinal anesthesia (SA) for infant surgical circumcision results in shorter postoperative times compared to general anesthesia (GA). We hypothesized that, relative to GA, SA would have significantly shorter post-operative recovery times without increasing operative time or postoperative complications relative to GA.

MATERIAL AND METHODS: A retrospective cohort study was conducted among infants receiving an outpatient surgical circumcision in the operating room (OR). The exposure was undergoing spinal anesthesia (n = 88) relative to unexposed patients undergoing general anesthesia (n = 105). The primary outcome was the total postoperative time (in minutes) from arriving in the post-anesthesia care unit (PACU) to discharging from the hospital. Secondary outcomes included total time in the operating room, time from entering the operating room to starting surgery, duration of the surgery, time from the end of surgery to leaving the operating room, and 30-day postoperative complications. Covariates of interest were age, weight, ASA class, anesthesiologist, and whether adjuvant anesthetics were administered. Patient and surgical characteristics were compared using non-parametric tests of association. Mixed-effect linear regression models were fit to test the association between SA and total post-op time and other outcomes.

RESULTS: There were 88 male infants in the SA group and 105 male infants in the GA group; both groups were similar in age, weight, ASA class and insurance status. The unadjusted analysis demonstrated that median total postoperative time was significantly lower for the SA group (39.5 min) compared to the GA group (104 min; p < 0.001) (see figure). There was no difference in total OR time (median 51 versus 48, p = 0.1) (see figure), pre-surgery OR time (median 18 versus 18, p = 0.6) or surgical time (median 27 versus 24, p = 0.6). There was a very slight statistical difference in post-surgery OR time favoring spinal anesthesia (mean 6.5 vs. 4.8, p < 0.001). When controlling for anesthesiologist, age, weight and ASA class, patients receiving SA had a 65.5 min (p < 0.001) shorter PACU stay compared to GA. There was no difference in postoperative complications between the two groups.

DISCUSSION: When compared to GA, male infants who underwent circumcision under SA had a faster hospital discharge by over an hour without impacting surgical or total OR times or complications. This reduction in recovery time may lead to cost savings for patients and hospitals, possibly allow for higher daily OR throughput and alleviate strain on PACU nurse staffing.