Minjae Kim1, Joanne E Brady2, Guohua Li2. 1. Department of Anesthesiology, Columbia University Medical Center, New York, NY. Electronic address: minjae.kim@columbia.edu. 2. Department of Anesthesiology, Columbia University Medical Center, New York, NY; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY.
Abstract
OBJECTIVE: Prior studies suggest that general anesthesia (GA) is associated with worse cardiopulmonary outcomes after endovascular abdominal aortic aneurysm repair (EVAR). Patients undergoing EVAR are at a high risk of developing perioperative acute kidney injury (AKI), and the relationship between anesthetic technique and AKI in these patients is not well-characterized. The authors sought to determine if anesthetic technique affected the risk of AKI in patients undergoing EVAR. DESIGN: Retrospective, observational cohort study analyzed using a multivariate logistic regression model to assess the effects of anesthetic technique on renal outcome. SETTING: Multiple institutions, mainly in North America. PARTICIPANTS: Patients in the American College of Surgeons National Surgical Quality Improvement Program from 2005-2010 undergoing EVAR. INTERVENTIONS: The authors investigated the association between anesthetic techniques, comparing GA to alternative (non-GA) techniques, and AKI. MEASUREMENTS AND MAIN RESULTS: AKI was defined as an increase in the creatinine level of>2 mg/dL and/or dialysis. Of 13,026 patients, 84.4% underwent GA and 15.6% underwent non-GA techniques. AKI developed in 2.0% of the GA group and 1.4% of the non-GA group (unadjusted odds ratio [OR] 1.43, p = 0.075; adjusted OR [aOR] 1.00, p = 0.99). Risk factors for AKI include ASA class, ruptured aneurysm, preoperative renal dysfunction, symptomatic cardiovascular disease, and perioperative blood transfusion. CONCLUSIONS: Anesthetic technique is not independently associated with the risk of AKI in patients undergoing EVAR.
OBJECTIVE: Prior studies suggest that general anesthesia (GA) is associated with worse cardiopulmonary outcomes after endovascular abdominal aortic aneurysm repair (EVAR). Patients undergoing EVAR are at a high risk of developing perioperative acute kidney injury (AKI), and the relationship between anesthetic technique and AKI in these patients is not well-characterized. The authors sought to determine if anesthetic technique affected the risk of AKI in patients undergoing EVAR. DESIGN: Retrospective, observational cohort study analyzed using a multivariate logistic regression model to assess the effects of anesthetic technique on renal outcome. SETTING: Multiple institutions, mainly in North America. PARTICIPANTS: Patients in the American College of Surgeons National Surgical Quality Improvement Program from 2005-2010 undergoing EVAR. INTERVENTIONS: The authors investigated the association between anesthetic techniques, comparing GA to alternative (non-GA) techniques, and AKI. MEASUREMENTS AND MAIN RESULTS: AKI was defined as an increase in the creatinine level of>2 mg/dL and/or dialysis. Of 13,026 patients, 84.4% underwent GA and 15.6% underwent non-GA techniques. AKI developed in 2.0% of the GA group and 1.4% of the non-GA group (unadjusted odds ratio [OR] 1.43, p = 0.075; adjusted OR [aOR] 1.00, p = 0.99). Risk factors for AKI include ASA class, ruptured aneurysm, preoperative renal dysfunction, symptomatic cardiovascular disease, and perioperative blood transfusion. CONCLUSIONS: Anesthetic technique is not independently associated with the risk of AKI in patients undergoing EVAR.