• Kate H Pool, Brittany N Burton, Alexander Beletsky, John J Finneran, and Rodney A Gabriel.
• Department of Anesthesiology, University of California, San Diego, La Jolla, CA.
• J. Cardiothorac. Vasc. Anesth. 2021 Nov 1; 35 (11): 3283-3287.

ObjectivesThe authors hypothesized that monitored anesthesia care (MAC)-either by local sedation or regional anesthesia (RA)-compared with general anesthesia (GA), would be associated with lower odds of significant 30-day postoperative complications and mortality in patients undergoing an ankle amputation.DesignRetrospective cohort study.SettingInpatient.ParticipantsThe authors used data from patients who underwent ankle amputation from the American College of Surgeons National Surgical Quality Improvement Program registry.InterventionRA as primary anesthetic.Measurements And Main ResultsA multivariate logistic regression was used to evaluate the association of primary anesthesia type with the outcomes. The regression analysis included all covariates to test the association of the primary exposure variable (anesthesia type) with each outcome of interest. The odds ratio (OR), with associated 95% confidence interval (CI), was reported for each covariate. There were a total of 3,368 patients undergoing guillotine amputation through the tibia/fibula (n = 2,935) or ankle disarticulation (n = 433). Among these patients, 15.5% (n = 491) received MAC as their primary anesthetic. Among all patients, 11.4% (n = 363) experienced a significant postoperative complication. On multivariate logistic regression, MAC was found to decrease odds of postoperative complications (OR 0.57, 95% CI 0.40-0.82, p = 0.002), but not mortality (OR 1.26, 95% CI 0.87-1.84, p = 0.22).ConclusionThis study showed that MAC was associated with improved outcomes, as opposed to GA, as the primary anesthetic in ankle amputations.Copyright © 2021 Elsevier Inc. All rights reserved.

13 keywords...

hide…