Societies for Pediatric Urology

SPU Home SPU Home Past & Future Meetings Past & Future Meetings

Back to 2024 Abstracts


Discharge One Hour Sooner: Comparing Post-Operative Metrics Between Spinal And General Anesthetics
Colton K. Leavitt, MD, Linnea E. Dixson, MD, Flora F. Liu, MD, Joshua Horns, PhD, Karen L. Freed, MD, M. Chad Wallis, MD, Anthony J. Schaeffer, MD.
University of Utah, Salt Lake City, UT, USA.


Background: Given data demonstrating the safety of spinal anesthesia (SA) in the pediatric population, its use in pediatric urology has increased. However, the conflicting data regarding intraoperative and postoperative times warrants further investigation. The aim of this study is to determine if patients receiving SA will have shorter postoperative times compared to those undergoing general anesthesia (GA). We hypothesized that SA will have significantly shorter post-operative times relative to GA.
Methods: A retrospective cohort study at a tertiary care pediatric hospital was conducted among infants receiving an outpatient circumcision in the operating room (OR). The exposure was undergoing SA with a standard dose of 1mg/kg of 0.5% bupivacaine with 1:200,000 epinephrine (n=88) relative to unexposed patients undergoing GA (n=105). Included patients underwent circumcision only with no additional procedures. The primary outcome was the total postoperative time, specifically the minutes from arriving in the post-anesthesia care unit to discharging from the hospital. Secondary outcomes included total OR time, pre-surgery OR time, surgery time, and post-surgery OR time. Additional variables included age, weight, ASA class, anesthesiologist, and whether adjuvant anesthetic medications 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, total surgical time, and each component of total OR time. Models were clustered on anesthesiologist.
Results: The two groups were similar in age, weight, ASA class and insurance status (Table 1). The median total postoperative time was significantly lower for the SA group (39.5 minutes) compared to the GA group (104 minutes; p<0.001). There was no difference in total OR time (median 51 versus 48, p=0.1), pre-surgery OR time (median 18 versus 18, p=0.6), surgical time (median 27 versus 24, p=0.6) or post-surgery OR time (median 5 versus 5, p<0.001). When controlling for anesthesiologist, age, weight and ASA class, receiving SA reduced total post-operative time by 65.5 minutes (p<0.001) compared to GA and ASA 3 increased total post-operative time by 24.8 minutes (p=0.01) compared to ASA 1(Table 2). Additionally, relative to GA, SA reduced post-surgery OR time by 1.4 minutes (p=0.01) and relative to ASA class 1, ASA class 3 patients undergoing SA had a 4.4 minute longer pre-surgery OR time (p=0.01) (Table 3). No other significant differences were identified in intra-operative or post-operative time.
Conclusions: When compared to GA, SA allowed for faster hospital discharge without impacting surgical or total OR times. This reduction in recovery time may also lead to cost savings for patients and hospitals and possibly allow for higher daily OR throughput.

Table 1: Baseline and intraoperative characteristics of general and spinal anesthetic groups
General Anesthesia N=105Spinal Anesthesia*N=88p-value
Baseline Characteristics
Age, median days (IQR)227 (197-285)236 (210-288)0.13
Weight, median kg (IQR)8.1 (7.4-8.8)8.25 (7.4-9)0.26
Insurance Type, n (%)0.16
Commercial81 (77.1)67 (76.1)
Public23 (21.9)18 (20.5)
Other (self-pay, government)1 (0.9)3 (3.4)
ASA Class, n (%)0.39
170 (66. 7)50 (56.8)
224 (22.9)29 (33.0)
37 (6. 7)7 (8.0)
44 (3.8)2 (2.37)
Intraoperative Characteristics
Number of anesthesiologists3514
Number of surgeons64
Preop midazolam, n (%)02 (2.3)0.16
IV adjuvants, Yes n (%)95 (90.5)11 (12.5)
Fentanyl/Hydromorphone, n (%)85 (81)0
Dexmedetomidine, n (%)22 (21)8 (9.1)
Propofol, n (%)33 (31.4)2 (2.3)
*analysis does not include 3 patients with attempted SA who were converted to GA.

Table 2: Intraoperative and postoperative times
General Anesthesia N=105Spinal AnesthesiaN=88p-value
Postoperative Time, median mins (IQR)
TOTAL104 (85-125)39.5 (33-53)<0.001
PACU I37 (30-44)0 (0-0)<0.001
PACU II67 (50-87)39 (32.8-51.5)<0.001
Intraoperative Time, median mins (IQR)
TOTAL51 (45-62)48 (43-58.3)0.11
Pre-surgery OR time18 (15-22)18 (15-21)0.6
Surgery time27 (21-33)24.5 (21-33)0.57
Post-surgery OR time5 (4-8)5 (4-6)<0.001
Mean (SD)6.5 (3.6)4.8 (1.7)

Table 3: Relationship between anesthetic type and average postoperative time in minutes
Unadjustedp-valueAdjusted (95% CI)p-value
Spinal Anesthetic (ref=General)-63.7 (-72.3- -54.2)<0.001-65.5 (-75.3- -55.7)<0.001
ASA class (ref=1)
20.57 (-12-13.5)0.96.8 (-3.9-17.4)0.2
316.5 (-5.2-38.2)0.124.8 (6.4-43.2)0.01
413.6 (-18.9-46.1)0.4-0.1 (-26.4-26.1)0.9
Weight (per 1 kg increase)2.5 (-2.3-7.2)0.33.4 (-0.8-7.5)0.1
Age (per 1 day increase)0.09 (-0.02-0.2)0.10.1 (-0.02-0.2)0.1

Back to 2024 Abstracts