Local anesthesia vs. general anesthesia in cochlear implant surgery: Impact on surgical duration, postoperative recovery, costs and clinical insights. An extensive meta-analysis

Introduction: recent studies have shown that around 30 % of men and 20 % of women at the age of 70 have a hearing loss, rates that rise to 55 % and 45 % respectively at the age of 80. Treatment options include hearing aids and cochlear implants. Cochlear implant surgery under local anesthesia (L.A.) is gaining popularity for its potential benefits. We analyzed the current literature comparing L.A. and general anesthesia (G.A.) surgery by assessing operation duration, post-operative observation time and length of hospital stay.

Methods: The study was conducted following the PRISMA guidelines. The search was performed on different database for articles published from 1984 to 2023. Comparative studies between cochlear implants in L.A. and G.A. with information on duration of surgery, length of hospital stay and time in postoperative care unit (PACU) were included.

Results: Of 65 articles identified, 5 studies were included, involving 634 patients. The studies showed that L.A. surgery had a shorter surgical time than G.A. (p < 0.0001). No significant differences were found in length of hospital stay (p = 0.14) or time in PACU (p = 0.08). The cost of anesthesia was significantly lower for L.A.

Discussion: The LA procedure has become popular, especially among elderly patients. The LA procedure has a shorter operative time and lower costs, without significantly affecting hospitalisation or time in PACU. Our study highlighted the advantages of L.A. in cochlear implant surgery, also showing the relatively low costs of the procedure. Better post-operative management could bring further benefits for patients and reduce hospital costs.