Comparing the Quality of Patient Recovery After Open Appendectomy Under General Versus Spinal Anesthesia: Prospective Cohort Study

Background: Open appendectomy is commonly performed under either general or spinal anesthesia. Postoperative quality of recovery, a multidimensional patient-centered measure of outcomes after surgery, is affected by the choice of anesthesia technique. Objective: The objective of our study was to compare the effects of general and spinal anesthesia on the immediate postoperative quality of recovery in adults undergoing open appendectomy. Methods: In this prospective cohort study, 74 patients were assigned to either the general (n=37) or the spinal anesthesia (n=37) groups. The primary outcome was the total Quality of Recovery-15 score measured 24 hours postoperatively. Secondary outcomes included postoperative pain scores, analgesic consumption, incidence of postoperative nausea and vomiting, time to first oral intake, time to first ambulation, and length of hospital stay. Intergroup comparisons were performed using the chi-square test, Fisher exact test, independent t test, or Mann-Whitney U test, as appropriate. Results: Patients in the spinal anesthesia group had significantly higher Quality of Recovery-15 scores than those in the general anesthesia group (P=.001). They also exhibited lower pain scores at 1, 2, 6, and 12 hours postoperatively (P<.001), reduced consumption of diclofenac and tramadol, and a decreased incidence of postoperative nausea and vomiting (P<.001). The time to first mobilization, time to first oral intake, and length of hospital stay were also significantly lower in the spinal anesthesia group (P<.001). Conclusions: Spinal anesthesia is the preferred anesthesia technique for patients undergoing open appendectomy. It may provide improved postoperative recovery, with lower pain scores and improved analgesia. It may also reduce the need for additional analgesics, decrease the incidence of nausea and vomiting, and improve intrahospital patient recovery trajectories.