Complications Associated with Anesthetic Choice for Elective Foot and Ankle Surgery

Abstract

Category: Ankle; Ankle Arthritis; Arthroscopy; Bunion; Diabetes; Hindfoot; Lesser Toes; Midfoot/Forefoot; Sports; Trauma Introduction/Purpose: Wide-awake anesthesia (local anesthesia without sedation) is rarely utilized during elective foot and ankle surgery. As such, the rate of post-operative complications following wide-awake foot and ankle surgery is unknown. The aim of this study was to compare rates of early post-operative complications for wide-awake anesthesia to general/local anesthesia with sedation for elective foot and ankle procedures conditional on a wide range of observable patient characteristics and risk factors. Methods: Patients that underwent an elective foot or ankle surgery were identified in the American College of Surgeon's National Surgical Quality Improvement Program (NSQIP) dataset. The rate of thirty-day post-operative complications was compared between patients who received wide-awake anesthesia and those who received general/local anesthesia with sedation using logistic regressions that controlled for patient risk factors. Results: Between 2005 and 2017, 85,363 patients were identified has having any foot and ankle procedure. After excluding observations with missing anesthesia type data information and non-elective foot and ankle procedures, the analytic cohort had 16,743 patients. There were 1,401 (8.4%) patients who underwent wide-awake anesthesia and 15,342 (91.6%) patients who underwent general/local anesthesia with sedation over the entire sample. Starting in 2007, there was an annual increase in the likelihood of using general/local anesthesia with sedation for foot and ankle procedures of 0.7 percentage points (p = 0.001). Overall, general/local anesthesia with sedation increased the odds of experiencing any complication within the first thirty days by 1.523 (95% CI 1.152 - 2.014). Conclusion: Although wide-awake surgery is rarely performed for elective foot and ankle procedures, utilization of local anesthesia without sedation may result in fewer post-operative complications in the first thirty days. Existing trends in the use of sedation for foot and ankle procedures show that physicians are increasingly favoring general/local anesthesia with sedation, but our findings caution against this choice and suggest that post-operative complication rates may correspondingly increase.