Introduction: Benign prostatic hyperplasia (BPH) surgery is typically performed under general (GA) or spinal anaesthesia (SA). SA is considered the anaesthetic of choice for as it facilitates early identification of transurethral resection of prostate (TURP) syndrome. However, SA may be associated with longer time spent in the recovery room. Previous studies have compared GA and SA in regards to post-operative pain, but not post-operative recovery. We compare post-operative recovery metrics after GA and SA for BPH surgery.
Methods: This was a retrospective review of 500 consecutive patients from March 2019 to July 2021 who underwent surgical management of BPH at Austin Health in Melbourne, Australia. Our institution performs greenlight laser photoselective vaporisation of prostate (PVP), monopolar and bipolar TURP. All continuous variables were normally distributed, presented as mean ± SD, and compared using the Student’s T-test and mean difference (MD) [95% CI]. Categorical variables were compared with the Chi-square test. Comparison of recovery time was achieved using multivariate linear regression.
Results: In total, 186 (37.2%) underwent SA for monopolar TURP (n=144, 77.4%), bipolar TURP (n=9, 4.8%) and PVP (n=33, 17.7%). In contrast, 314 (62.8%) underwent GA for monopolar TURP (n=213, 67.8%), bipolar TURP (n=6, 1.9%) and PVP (n=95, 30.3%). SA patients were older than GA patients (73.1 ± 8.9 vs 71.2 ± 8.9 years, MD 1.9 [0.3-3.5], p=0.02), but similar in terms of ASA (p=0.17) and prostate volume (67.3 ± 35.0 cc vs 67.7 ± 38.3 cc, p=0.91). As expected, anaesthetic time was longer for SAs (31.5 ± 11.7 vs 26.6 ± 25.3 minutes, MD 4.9 [2.8-7.0], p<0.001), but total operating room time was similar (76.7 ± 26.6 vs 75.7 ± 29.3 minutes, p=0.72). TURP syndrome amongst SAs and GAs were identical (1.6% vs 1.6%, p=0.99). Recovery room time (82.8 ± 57.2 vs 74.7 ± 42.7 minutes, p=0.07) and length-of-stay (2.5 ± 2.0 vs 2.3 ± 3.3 days, p=0.42) were similar after SA and GA. In multivariate analysis, higher ASA score (p < 0.001), PVP surgery (p=0.03), longer resection time (p=0.04) and TURP syndrome (p=0.008) were associated with greater time spent in the recovery room, but choice of anaesthetic was non-significant (p=0.37).
Conclusions: Although our study does not prove if SA can facilitate early identification of TURP syndrome, we have shown that the method of anaesthesia does not significantly impact time spent in the operating room and recovery room or inpatient length-of-stay. This may further support the ongoing use of SA for BPH surgery.
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