P010: COMPARING THE OUTCOMES OF SPINAL ANESTHESIA VERSUS GENERAL ANESTHESIA IN LAPAROTOMIES AT RESOURCE-LIMITED CENTERS.
Christian-Michael Gopichand1; Gebrehiwot A Tegu, MSc2; Adane Getachew, MD2; Destaalem Araya, MD3; Kidist Asratie, Bsc2; Masresha G Tekelhaimanot, BSc3; Agenchew Nega, BSc3; Susan Nabulindo, MD4; John Kamau, BSc5; Christina Jelly, MD6; Mark Newton, MD6; Bantayehu Sileshi, MD6
1Meharry Medical College; 2Bahir Dar University, Bahir Dar, Ethiopia; 3Mekelle University, Mekelle, Ethiopia; 4University of Nairobi, Nairobi, Kenya; 5AIC Kijabe Hospital, Kijabe, Kenya; 6Vanderbilt University Medical Center
Spinal anesthesia is utilized at a higher rate in low-resource centers compared to high-resource countries. In high-resource settings, laparotomies, procedures that typically require abdominal muscle relaxation, are almost exclusively performed under general anesthesia. While spinal anesthesia has gained popularity in low-resource centers, limited data exist regarding its safety as an alternative to general anesthesia for laparotomies. This study aims to investigate the efficacy of spinal anesthesia compared to general anesthesia by examining patient mortality outcomes.
This study is a retrospective cohort analysis assessing outcome differences between spinal anesthesia and general anesthesia for laparotomies in low-resource centers. We utilized previously collected data from the “Global Perioperative Outcomes” study, spanning from 2014 to 2021. The dataset includes key patient demographics and perioperative outcomes from 32 hospitals in Kenya and Ethiopia, comprising a total of 5,293 patients who underwent laparotomies. Postoperatively, we monitored patients for incidences of death or perioperative complications, focusing on 24-hour and 7-day mortality rates as our primary outcome variables. Unadjusted analyses were performed to compare the mortality rates between spinal and general anesthesia. Multivariate analyses are currently pending to adjust for hospital type, ASA status, age, length of surgery, emergency status, trauma status, and country, as well as to calculate hospital length of stay.
Patients who underwent laparotomy procedures and met our inclusion criteria were selected for analysis, while cases that did not involve laparotomy procedures were excluded. Among the 5,293 reported laparotomy cases, 4,470 (84%) received general anesthesia, and 581 (11%) received spinal anesthesia. Of the laparotomies performed under general anesthesia, 3,051 (69%) were emergency cases, compared to 119 (21%) of emergency cases utilizing spinal anesthesia. Additionally, among patients classified as ASA III or higher, 3,051 (69%) underwent general anesthesia, while 119 (21%) received spinal anesthesia.
Our primary outcomes of interest were 24-hour and 7-day mortality. A total of 71 (1.5%) 24-hour mortalities and 155 (3.7%) cumulative 7-day mortalities were reported. In the unadjusted analyses, compared to general anesthesia, the odds of 7-day mortality were lower in patients who received spinal anesthesia (OR = 0.2, CI: 0.07-0.54). However, the odds of 24-hour mortality were similar between the two groups (OR = 0.35, CI: 0.11-1.09).
While the data suggests a possible association between spinal anesthesia and reduced 7-day mortality compared to general anesthesia for laparotomies, further analyses and prospective studies are needed to confirm this association. If these results hold true, expansion of spinal anesthesia for laparotomies could be considered, which would have a significant financial benefit in low resource settings.
Table 1. Surgical case data of laparotomy and non-laparotomy procedures.
Table 2. Characteristics of patients who received general and spinal anesthesia for laparotomies
Table 3. Mortality in patients who received general and spinal anesthesia for laparotomies.
