Kathryn Van Orden1, Alik Farber1, Marc L Schermerhorn2, Philip P Goodney3, Jeffrey A Kalish1, Douglas W Jones1, Denis Rybin4, Jeffrey J Siracuse5. 1. Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass. 2. Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass. 3. Division of Vascular and Endovascular Surgery, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Lebanon, NH. 4. Department of Biostatistics, Boston University, School of Public Health, Boston, Mass. 5. Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass. Electronic address: jeffrey.siracuse@bmc.org.
Abstract
OBJECTIVE: Percutaneous endovascular aneurysm repair (EVAR) can be performed with general anesthesia (GA) or local anesthesia (LA). Our goal was to assess perioperative outcomes comparing anesthesia type in percutaneous EVAR. METHODS: The Vascular Quality Initiative database was queried for all exclusively percutaneous EVAR procedures. Univariable analysis was used to compare which patients were offered LA. Multivariable analysis was used to determine the independent effect of anesthesia type. RESULTS: There were 8141 percutaneous EVARs identified in the Vascular Quality Initiative database. Average age was 73 years, and 83% were male. GA and LA were used in 7387 (90.7%) and 754 (9.3%) cases, respectively. GA was used more often in patients who were younger (72.8 ± 8 vs 74.3 ± 9), white (89% vs 84.5%), and on Medicare (62% vs 61.5%); in patients with higher body mass index (28.3 ± 6 vs 27.3 ± 7), hypertension (81.5% vs 77.8%), diabetes (20.5% vs 17.4%), and previous lower extremity bypass (1.7% vs 0.5%); and in patients undergoing elective repair (86.4% vs 81.3%). Use of GA was associated with lower rates of preoperative congestive heart failure (11.6% vs 16.1%), preoperative anticoagulation (11.7% vs 14.2%), and less use of ultrasound guidance (81.5% vs 88.8%; P < .05). There was no difference in patients with chronic obstructive pulmonary disease, coronary artery disease, previous aneurysm repair, and concomitant iliac aneurysm repair. Multivariable analysis showed that GA compared with LA was associated with more pulmonary complications (odds ratio, 2.8; 95% confidence interval, 1.49-5.43; P = .002) and prolonged operative time (means ratio, 1.11; 95% confidence interval, 1.08-1.52; P < .001). There was no independent effect on overall complications, cardiac complications, or mortality. CONCLUSIONS: Although it was used in only 1 in 10 cases of percutaneous EVAR, LA was associated with fewer pulmonary complications after adjustment for patient factors. Surgeons should consider expanding the use of LA for percutaneous EVAR when feasible.
OBJECTIVE: Percutaneous endovascular aneurysm repair (EVAR) can be performed with general anesthesia (GA) or local anesthesia (LA). Our goal was to assess perioperative outcomes comparing anesthesia type in percutaneous EVAR. METHODS: The Vascular Quality Initiative database was queried for all exclusively percutaneous EVAR procedures. Univariable analysis was used to compare which patients were offered LA. Multivariable analysis was used to determine the independent effect of anesthesia type. RESULTS: There were 8141 percutaneous EVARs identified in the Vascular Quality Initiative database. Average age was 73 years, and 83% were male. GA and LA were used in 7387 (90.7%) and 754 (9.3%) cases, respectively. GA was used more often in patients who were younger (72.8 ± 8 vs 74.3 ± 9), white (89% vs 84.5%), and on Medicare (62% vs 61.5%); in patients with higher body mass index (28.3 ± 6 vs 27.3 ± 7), hypertension (81.5% vs 77.8%), diabetes (20.5% vs 17.4%), and previous lower extremity bypass (1.7% vs 0.5%); and in patients undergoing elective repair (86.4% vs 81.3%). Use of GA was associated with lower rates of preoperative congestive heart failure (11.6% vs 16.1%), preoperative anticoagulation (11.7% vs 14.2%), and less use of ultrasound guidance (81.5% vs 88.8%; P < .05). There was no difference in patients with chronic obstructive pulmonary disease, coronary artery disease, previous aneurysm repair, and concomitant iliac aneurysm repair. Multivariable analysis showed that GA compared with LA was associated with more pulmonary complications (odds ratio, 2.8; 95% confidence interval, 1.49-5.43; P = .002) and prolonged operative time (means ratio, 1.11; 95% confidence interval, 1.08-1.52; P < .001). There was no independent effect on overall complications, cardiac complications, or mortality. CONCLUSIONS: Although it was used in only 1 in 10 cases of percutaneous EVAR, LA was associated with fewer pulmonary complications after adjustment for patient factors. Surgeons should consider expanding the use of LA for percutaneous EVAR when feasible.
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