Utilization of regional versus general anesthesia and its impact on lower extremity bypass outcomes

Michael D. Sgroi, Graeme McFarland, Matthew Mell

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: Previous studies evaluating general anesthesia (GA) vs regional (epidural/spinal) anesthesia (RA) for infrainguinal bypass have produced conflicting results. The purpose of this study was to analyze the factors associated with contemporary use of RA and to determine whether it is associated with improved outcomes after infrainguinal bypass in patients with critical limb ischemia. Methods: Using the Vascular Quality Initiative infrainguinal database, a retrospective review identified all critical limb ischemia patients who received an infrainguinal bypass from 2011 through 2016. Patients were then separated by GA or RA. Primary outcomes were perioperative mortality, complications, and length of stay. Predictive factors for RA and perioperative outcomes were analyzed using a mixed-effects model to adjust for center differences. Results: There were 16,052 patients identified to have a lower extremity bypass during this time frame with 572 (3.5%) receiving RA. There was a wide variation in the use of RA, with 31% of participating centers not using it at all. Age (67.2 vs 70.3 years; P < .001), chronic obstructive pulmonary disease (25.7% vs 30.9%; P < .001), and urgency of the operation (75.7% vs 80.4%; P = .01) were found to be independently associated with receiving a regional anesthetic. Univariate and multivariate analysis demonstrated that length of stay (6.8 days vs 5.7 days; P < .01), postoperative congestive heart failure (2.3% vs 1.1%; P = .040), and change in renal function (5.7% vs 2.9%; P = .005) were all significant outcomes in favor of RA. There was a trend toward lower mortality rates; however, this did not reach statistical significance. Rates of myocardial infarction, pulmonary complications, and stroke were not found to be statistically different. Coarsened exact matching continued to demonstrate a difference in length of stay and rates of new-onset congestive heart failure in favor of RA. Conclusions: RA is an infrequent but effective form of anesthesia for infrainguinal bypass surgery. Elderly patients and those with underlying respiratory problems may benefit from this form of anesthesia. Further evaluation within institutions should be performed to identify which patients would most benefit from RA or GA.

Original languageEnglish (US)
JournalJournal of Vascular Surgery
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

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Epidural Anesthesia
Spinal Anesthesia
General Anesthesia
Lower Extremity
Length of Stay
Ischemia
Extremities
Anesthesia
Heart Failure
Mortality
Chronic Obstructive Pulmonary Disease
Statistical Factor Analysis
Blood Vessels
Anesthetics
Multivariate Analysis
Stroke
Myocardial Infarction
Databases
Kidney
Lung

Keywords

  • Bypass
  • Regional anesthesia
  • VQI

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Utilization of regional versus general anesthesia and its impact on lower extremity bypass outcomes. / Sgroi, Michael D.; McFarland, Graeme; Mell, Matthew.

In: Journal of Vascular Surgery, 01.01.2019.

Research output: Contribution to journalArticle

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N2 - Objective: Previous studies evaluating general anesthesia (GA) vs regional (epidural/spinal) anesthesia (RA) for infrainguinal bypass have produced conflicting results. The purpose of this study was to analyze the factors associated with contemporary use of RA and to determine whether it is associated with improved outcomes after infrainguinal bypass in patients with critical limb ischemia. Methods: Using the Vascular Quality Initiative infrainguinal database, a retrospective review identified all critical limb ischemia patients who received an infrainguinal bypass from 2011 through 2016. Patients were then separated by GA or RA. Primary outcomes were perioperative mortality, complications, and length of stay. Predictive factors for RA and perioperative outcomes were analyzed using a mixed-effects model to adjust for center differences. Results: There were 16,052 patients identified to have a lower extremity bypass during this time frame with 572 (3.5%) receiving RA. There was a wide variation in the use of RA, with 31% of participating centers not using it at all. Age (67.2 vs 70.3 years; P < .001), chronic obstructive pulmonary disease (25.7% vs 30.9%; P < .001), and urgency of the operation (75.7% vs 80.4%; P = .01) were found to be independently associated with receiving a regional anesthetic. Univariate and multivariate analysis demonstrated that length of stay (6.8 days vs 5.7 days; P < .01), postoperative congestive heart failure (2.3% vs 1.1%; P = .040), and change in renal function (5.7% vs 2.9%; P = .005) were all significant outcomes in favor of RA. There was a trend toward lower mortality rates; however, this did not reach statistical significance. Rates of myocardial infarction, pulmonary complications, and stroke were not found to be statistically different. Coarsened exact matching continued to demonstrate a difference in length of stay and rates of new-onset congestive heart failure in favor of RA. Conclusions: RA is an infrequent but effective form of anesthesia for infrainguinal bypass surgery. Elderly patients and those with underlying respiratory problems may benefit from this form of anesthesia. Further evaluation within institutions should be performed to identify which patients would most benefit from RA or GA.

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