Global anaesthesia practice using inguinal hernia surgery as a tracer condition: a secondary analysis of an international prospective cohort study

Introduction: 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. Methods: 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. Results: 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. Discussion: 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.