Patients undergoing elective surgery may fare better if they receive regional anesthesia (RA) instead of general anesthesia (GA), according to researchers at Vanderbilt University Medical Center, in Nashville, Tenn.
The study found that 0.81% of adults receiving RA died within 30 days of surgery, compared with 1.13% of those receiving GA (abstract JS01). It’s a small percentage difference, said lead author Nahel Saied, MB BCh, associate professor of clinical anesthesiology, Division of Anesthesiology Critical Care Medicine at Vanderbilt, “but over large numbers of patients, it adds up.”
Regional anesthesia was associated with lower odds for 30-day mortality as well as postoperative respiratory and renal complications, especially in general surgery patients. This choice also was particularly beneficial in patients with prior renal failure, reducing the odds of 30-day mortality and respiratory complications.
“The take-home message is if RA is an option, we should consider it,” Dr. Saied said, although physicians still need to determine which patients are most likely to benefit.
Dr. Saied and his colleagues analyzed pooled data from the American College of Surgeons’ National Surgical Quality Improvement Program database from 2005 to 2011, pulling records for 682,362 elective surgical procedures, including hernia repairs, knee and hip replacements, and cystoscopies. They compared 30-day mortality and postoperative complications such as respiratory failure, myocardial infarction (MI) and deep venous thrombosis between patients who received RA and GA during surgery, using multiple logistic regression analysis to examine these associations and account for confounders.
After adjustment for demographic characteristics, type and length of surgery, smoking, alcohol use, body mass index and preoperative comorbidities, the odds of 30-day mortality were 46% lower in patients given RA than in those with GA (95% confidence interval [CI], 7%-69%; P<0.001) among general surgery patients and 68% lower in patients with preexisting renal failure (95% CI, 36%-84%). The odds of major postoperative complications were 40% lower in patients receiving RA (odds ratio, 0.60; P<0.001), the authors noted. However, there was no significant effect of anesthesia technique on pulmonary embolism, perioperative MI or peripheral nerve injury.
Comparing anesthesia outcomes retrospectively in a study such as this is difficult, said Mark Neuman, MD, assistant professor of anesthesiology and critical care at the University of Pennsylvania School of Medicine, in Philadelphia.
“From a clinical standpoint, it’s possible that the type of anesthesia” is what accounted for the difference in outcomes, but other factors could have affected the findings. The type of anesthesia that patients received may depend on how sick they were or the quality of care at the hospital where their surgeries were performed. It also is possible that RA was beneficial in only the subset of procedures studied.
“The findings are provocative and interesting, but demand follow-up in a randomized controlled clinical trial,” Dr. Neuman said.
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