• J. Vasc. Surg. · Jul 2012

    Multicenter Study

    Outcomes of carotid endarterectomy under general and regional anesthesia from the American College of Surgeons' National Surgical Quality Improvement Program.

    • Stefan W Leichtle, Nicolas J Mouawad, Kathleen Welch, Richard Lampman, Walter M Whitehouse, and Michael Heidenreich.
    • Department of Surgery, Saint Joseph Mercy Health System, Ann Arbor, MI 48106, USA. stefan.leichtle@yahoo.com
    • J. Vasc. Surg. 2012 Jul 1;56(1):81-8.e3.

    ObjectiveDespite multiple studies over more than 3 decades, there still is no consensus about the influence of anesthesia type on postoperative outcomes following carotid endarterectomy (CEA). The objective of this study was to investigate whether anesthesia type, either general anesthesia (GA) or regional anesthesia (RA), independently contributes to the risk of postoperative cardiovascular complications or death using the American College of Surgeons' National Surgical Quality Improvement Program (ACS NSQIP) database.MethodsRetrospective analysis of elective cases of CEA from 2005 through 2009 was performed. A propensity score model using 45 covariates, including demographic factors, comorbidities, stroke history, measures of general health, and laboratory values, was used to adjust for bias and to determine the independent influence of anesthesia type on postoperative stroke, myocardial infarction (MI), and death.ResultsOf 26,070 cases listed in the ACS NSQIP database, GA and RA were used in 22,054 (84.6%) and 4016 (15.4%) cases, respectively. Postoperative stroke, MI, and death occurred in 360 (1.63%), 133 (0.6%), and 154 (0.70%) patients of the GA group, respectively, and in 58 (1.44%), 11 (0.27%), and 27 (0.67%) patients of the RA group, respectively. Stratification by propensity score quintile and adjustment for covariates demonstrated GA to be a significant risk factor for postoperative MI with an adjusted odds ratio (OR) and confidence interval (CI) of 2.18 (95% CI, 1.17-4.04), P = .01 in the entire study population. The OR for MI was 5.41 (95% CI, 1.32-22.16; P = .019) in the subgroup of patients with preoperative neurologic symptoms, and 1.44 (95% CI, 0.71-2.90; P = .31) in the subgroup of patients without preoperative neurologic symptoms.ConclusionsThis analysis of a large, prospectively collected and validated multicenter database indicates that GA for CEA is an independent risk factor for postoperative MI, particularly in patients with preoperative neurologic symptoms.Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

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