Advanced healthcare utilisation after monitored anaesthesia care versus general anaesthesia: A real-world data analysis

BACKGROUND For a large variety of surgeries and interventional procedures, monitored anaesthesia care (MAC) can be a viable alternative to general anaesthesia (GA). MAC can avoid risks associated with intubation and deep sedation while increasing the risk of aspiration and intra-procedural respiratory complications due to the lack of a definitive airway. It remains unclear how these competing risks impact postoperative complications and the level of healthcare utilisation after procedures where both approaches are viable options. METHODS This retrospective cohort study included adult patients undergoing procedures feasible under MAC and GA at Beth Israel Deaconess Medical Center in Boston, Massachusetts, USA. Advanced postoperative healthcare utilisation (7-day unplanned intensive care unit (ICU) admission, 30-day hospital readmission, or non-home discharge) after MAC versus GA was analysed using multivariable logistic regression adjusted for a priori defined confounders and an inverse probability weighted regression adjustment analysis. RESULTS Among 63,224 included patients, 29,611 (46.8%) patients underwent MAC, and 33,613 (53.2%) underwent GA. 1,714 (2.7%) underwent postoperative ICU admission, 2,678 (4.2%) patients were readmitted, and 3,771 (6.0%) were discharged to a non-home setting. Overall, 7,020 (11.1%) patients required advanced postoperative healthcare utilisation. MAC was associated with a lower risk of advanced postoperative healthcare utilisation (ORadj 0.69;95%CI 0.64 to 0.74;ATEadj -2.3%;95%CI -3.0% to -1.7%; P < 0.001), with 16.6% of this association mediated by lower rates of haemodynamic instability. CONCLUSIONS Among procedures where either technique is a viable option, MAC was associated with a lower risk of advanced postoperative healthcare utilisation.