Anesthesia Type Impacts Aortic Aneurysm Repair Outcome

General anesthesia tied to higher pulmonary morbidity, length of stay than other anesthesias

TUESDAY, Nov. 1 (HealthDay News) -- Use of general anesthesia in endovascular repair of infrarenal abdominal aortic aneurysms (EVARs) is associated with an increase in pulmonary morbidity and length of stay (LOS) compared to spinal or local/monitored anesthesia care (local/MAC), according to a study published in the November issue of the Journal of Vascular Surgery.

Matthew S. Edwards, M.D., from the Wake Forest University School of Medicine in Winston-Salem, N.C., and colleagues investigated the outcomes of 6,009 elective EVARs performed between 2005 and 2008 using different anesthesia techniques: general, spinal, epidural, and local/MAC (4,868, 419, 331, and 391 subjects, respectively). Assessments were made of patient-level comorbidities, characteristics, and intra- and post-operative details. Individual and aggregate complications were analyzed, including wound, pulmonary, renal, venous thromboembolic, cardiovascular, operative, and septic. LOS and 30-day mortality were analyzed.

The investigators found that the 30-day mortality rate was 1.1 percent, and 11 percent of the patients had defined morbidity. The median and mean LOS was 2.0 and 2.8 ± 4.3 days, respectively. In multivariate analysis, significant associations were found between anesthesia type, pulmonary morbidity, and log LOS. The odds of pulmonary morbidity were higher with general anesthesia than with spinal (odds ratio [OR], 4.0) and local/MAC anesthesia (OR, 2.6). General anesthesia increased LOS by 10 and 20 percent versus spinal and local/MAC anesthesia, respectively. For general versus epidural anesthesia, no trends toward higher pulmonary morbidity and LOS were noted. There was no significant association seen between anesthesia type and mortality.

"These data support an increase in the use of local anesthesia/MAC or spinal anesthesia in EVAR patients," the authors write.

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