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Time spent under anesthesia could up risk

WASHINGTON, Jul 20, 2005 (United Press International via COMTEX) -- The length of time spent under general anesthesia during surgery determines the risk of postoperative complications and recovery periods for patients of all ages, new research has found.

There is not enough evidence, however, to prove that the risk is not a result of the complexity of lengthy surgery itself, the researchers said.

The study appears this week in the Archives of Otolaryngology-Head and Neck Surgery, published by the Journal of the American Medical Association.

For patients of all ages the risk of complications increases between 18 percent and 36 percent for each hour under anesthesia -- with the average anesthesia time just under four hours -- the researchers found. Complications range from fever to pneumonia and heart attack.

"There are other studies that have shown that for elderly patients there is a bias, and therefore (physician) recommendations for treatment for their diseases may be different than if it were a younger patient," Dr. Marina Boruk, study author and chief resident at the State University of New York Downstate Medical Center in Brooklyn, told United Press International. "Our study disproves that myth."

Boruk and colleagues evaluated data in 157 cases of major head and neck surgeries -- many associated with cancer -- over four years to determine if age was a factor in post-surgical complications related to anesthesia. They found no significant connection between complications and length of anesthesia recovery in surgical patients over age 70.

Dr. Robert Goldstein, a board-certified anesthesiologist and executive vice president at Somnia Inc., an office and ambulatory anesthesia service company in New York City, said data from major head and neck surgeries for cancer, heart and lung disease do not necessarily imply the same anesthesia risk for all such procedures.

"If you're 65 or you're 85 and you have to have neck surgery for cancer, you're not going to not do it because you fit into a risk category -- you have to have it done," Goldstein told UPI. "Those are very long procedures and those tend to be sick patients ... you're not comparing (these patients to) healthy people having an eight-hour surgery."

Goldstein said he presented a related study last May at a conference by the Society for Ambulatory Anesthesia. That study found healthy patients who underwent head and neck surgeries -- such as facial-plastic procedures -- in an accredited office-based surgical center and received anesthesia from a board-certified anesthesiologist did not experience complications related to time spent under general anesthesia.

"The aging population that we're faced with every day certainly is a contributing factor to patients' risk under anesthesia," Goldstein said. "Logic would prevail that someone that is less healthy as a result of being older would be a higher risk."

Dr. James Weller, staff anesthesiologist at Bethesda North Hospital in Cincinnati, said the amount of time spent under general anesthesia usually reflects the complexity of the surgery and the extensiveness of the disease being treated. Therefore, it is difficult, Weller told UPI, to separate the effects of anesthesia from those of the actual surgery -- particularly when the surgery is major.

Boruk said she took such factors into account in her study evaluation, but she recommended that future studies address whether the type and complexity of the surgery or the time of anesthesia increases the risk of complications.

"Our findings merit further studies to be done as far as teasing out these factors that go into (time under general anesthesia) and to see which ones are more important," she said.

Boruk said possible risks associated with length of anesthesia can be reduced by having surgical teams work on different parts of the body during multi-procedural surgeries, or by staging surgical procedures so the patient undergoes more than one surgery but is under anesthesia for a shorter amount of time during each procedure.

Goldstein suggested that patients discuss the option of staging procedures with their doctors to evaluate whether the potential benefits of less time under anesthesia outweighs the potential risks of undergoing multiple surgeries.

Weller agreed, saying unless there is a medical reason for a patient to undergo separate surgeries -- such as to recover from a particularly intensive or life-threatening procedure -- it is not recommended that patients stage procedures simply to lessen their anesthesia time.

No matter the age of the patient or the type of surgery, the best way to reduce the potential risk of anesthesia complications is to ask questions, Goldstein said.

"There's this complacency that takes place because all of a sudden anesthesia outcomes have improved, access and demand to surgical procedures as a result of technology and facilities has increased, and there's this stress on the system," he said.

Patients should ask about the qualifications of the person administering anesthesia, such as whether he or she is board-certified, whether the facility where the surgery is being performed is accredited, and whether the equipment being used during the surgical process is up-to-date and meets board standards, Goldstein said.

"As a consumer it is ... incumbent upon you to ask a lot of questions," he said. "You have to advocate for yourself as a patient, (and) if you've done that you've put yourself in a really terrific position to have a successful outcome."

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Catherine Sharoky is an intern for UPI Science News. E-mail: sciencemail@upi.com

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