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Combined Neuraxial and General Anesthesia Significantly Improves Perioperative Outcomes Following Elective Open Abdominal Aortic Aneurysm Repair

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Authors: Konrad Salata, MD et al
Journal of Vascular Surgery October 2019 Volume 70, Issue 4, Page e110
Objective

Evidence for the use of neuraxial anesthesia (NA) in the context of open abdominal aortic aneurysm (AAA) repair is sparse. The purpose of this study was to determine the 90-day outcomes of combined general and NA versus general anesthesia without neuraxial (GA) for elective open AAA repair.

Methods

A retrospective population-based cohort study was conducted using Ontario administrative health data from 2003 to 2016. Patients undergoing open AAA with NA versus GA were identified using diagnostic, procedure, and billing codes. A propensity score for NA was used to construct inverse probability of treatment weighted regression models to assess differences in 90-day mortality, major adverse cardiovascular events (MACE), acute kidney injury (AKI), dialysis, respiratory failure, mechanical ventilation days, intensive care unit (ICU) and hospital lengths of stay, and discharge home.

Results

A total of 10,477 elective open AAA repairs were identified, with 9003 (85%) NA and 1444 (14%) GA patients. Neuraxial patients had significantly lower hazards for all-cause mortality (hazard ratio [HR], 0.47; 95% confidence interval [CI], 0.37-0.61; P < .0001), MACE (HR, 0.72; 95% CI, 0.60-0.86; P = .0002) and stroke (HR, 0.54; 95% CI, 0.31-0.96; P = .04). Furthermore, NA patients were at lower odds for AKI (odds ratio [OR], 0.66; 95% CI, 0.49-0.89; P = .0058), respiratory failure (OR, 0.41; 95% CI, 0.36-0.47; P < .0001), and limb complications (OR, 0.30; 95% CI, 0.25-0.37; P < .0001), with significantly higher odds to be discharged home (OR, 1.32; 95% CI, 1.15-1.51; P < .0001). NA was also associated with significant mechanical ventilation and ICU and hospital length of stay benefits.

Conclusions

NA in open AAA repair patients is associated with reduced risk of 90-day mortality, MACE, stroke, AKI, dialysis, respiratory failure, limb complications, and shorter mechanical ventilation times, ICU and hospital lengths of stay, as well as higher likelihood for discharge home. NA should be considered as a standard adjunct to general anesthesia in open AAA repairs.

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