Trends in the Use of Neuraxial vs. General Anaesthesia for Transurethral Resection of the Prostate.

Abstract

Objective: Historically, neuraxial anaesthesia (NA) was preferred for transurethral resection of the prostate (TURP) to allow monitoring for TURP syndrome, but modern surgical techniques have largely eliminated this risk. We aimed to characterise trends in anaesthesia utilisation for TURP over a 15-year period and to identify patient factors associated with anaesthetic technique selection.

Methods: We performed a retrospective cohort study of patients undergoing primary TURP using the ACS-NSQIP database (2009-2023). Multivariable logistic regression identified predictors of the use of general anaesthesia (GA) versus NA. Subgroup analyses examined trends by patient health status and age.

Results: Of 73,214 patients identified, GA utilisation increased significantly from 69.9% in 2009 to 88.8% in 2023 (P < 0.001). In multivariable analysis, each successive year was associated with a 15% increase in the odds of receiving GA [odds ratio (OR) 1.15, 95% confidence interval (CI) 1.14-1.15]. Black patients (OR 1.65, 95% CI 1.47-1.87) had higher odds of GA than white patients, and hispanic patients (OR 1.51, 95% CI 1.38-1.64) had higher odds of GA than non-hispanic patients. Conversely, older age, chronic obstructive pulmonary disease (OR 0.77, 95% CI 0.71-0.84), and diabetes (OR 0.88, 95% CI 0.84-0.93) were associated with decreased GA use. The shift towards GA was significantly more pronounced among medically complex patients (American Society of Anesthesiologists 3-4) than among less medically complex patients (P=0.005).

Conclusion: The anaesthetic management of TURP has evolved over the last 15 years, and GA has further solidified its status as the dominant modality. This evolution likely reflects the diminished risk of TURP syndrome, allowing practice to be driven by airway control and efficiency rather than by historical safety constraints.