Ann Vasc Surg. 2022 Nov 26:S0890-5096(22)00729-4. doi: 10.1016/j.avsg.2022.10.008. Online ahead of print.
ABSTRACT
OBJECTIVES: Thoracic Endovascular Aortic Repair (TEVAR) is a minimally invasive surgery for repairing thoracic aneurysms and dissections. This study aims to compare postoperative outcomes of TEVAR performed under general versus locoregional anesthesia.
MATERIAL AND METHODS: Utilizing the 2008-2019 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, patients older than the age of 18 years who received TEVAR, were identified using the following current procedural terminology codes: 33880, 33881, 33883, 33884, or 33886. Patients who underwent concomitant procedures, those with both thoraco-abdominal and abdominal aortic pathologies, and trauma cases were excluded. Standard descriptive statistics, in addition to χ2, Fisher’s exact, and Mann-Whitney U tests were used to compare patient baseline characteristics and postoperative outcomes between general and locoregional anesthesia groups, as appropriate. Univariable and multivariable logistic regression analyses were performed to assess independent predictors of hospital length of stay (LOS) greater than 7 days.
RESULTS: Of the 1,028 patients included in the study, 86.5% received general anesthesia, and 13.5% received locoregional anesthesia, such as local anesthesia with monitored anesthesia care or regional anesthesia. No significant differences were found between patients receiving locoregional vs general anesthesia in mortality (3.6% vs 7.9%, respectively, p=0.071) and morbidity (18.7% and 24.8%, respectively, p=0.121) within 30 days post-TEVAR, including any wound, pulmonary, thromboembolic, renal, septic, and cardiac arrest complications. Patients who received general anesthesia had significantly higher median LOS compared to those who received locoregional anesthesia [5 days (IQR: 3-10) vs 4 days (IQR: 2-7), p=0.002], with 34.3% of the general anesthesia group having a LOS greater than 7 days compared to 21.6% of locoregional anesthesia group, p=0.003. On multivariable logistic regression analysis, general anesthesia was found to be an independent predictor of prolonged LOS greater than 7 days (OR: 1.72, 95% CI: 1.05-2.81, p=0.031).
CONCLUSION: Locoregional anesthesia results in significantly lower postoperative hospital LOS with similar postoperative mortality and morbidity compared to general anesthesia in patients undergoing TEVAR.
PMID:36574571 | DOI:10.1016/j.avsg.2022.10.008
