Meier et al1 report a large retrospective analysis of Veterans Affairs Surgical Quality Improvement Program evaluating the benefits of local anesthesia for open repair vs laparoscopic repair on inguinal hernia. While there is always risk for selection bias when considering why a surgeon chooses one approach over another, the authors have made every attempt to control for these factors and mitigate this bias. The idea of evaluating the effects of anesthesia on short-term outcomes is both novel and relevant. Given that many patients with inguinal hernias are older, the unintended consequences of prolonged general anesthesia should be carefully considered.