Results of endovascular aortic aneurysm repair with general, regional, and local/monitored anesthesia care in the American College of Surgeons National Surgical Quality Improvement Program database.
Results of endovascular aortic aneurysm repair with general, regional, and local/monitored anesthesia care in the American College of Surgeons National Surgical Quality Improvement Program database.
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DOI：
10.1016/j.jvs.2011.04.054
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发表时间：
2011-11
影响因子：
4.3
通讯作者：
Hansen KJ
中科院分区：
文献类型：
--
作者：
Edwards MS;Andrews JS;Edwards AF;Ghanami RJ;Corriere MA;Goodney PP;Godshall CJ;Hansen KJ
本研究在反映当代麻醉和手术实践的多中心北美医院数据库中检查了使用全身、脊髓、硬膜外和局部/监测麻醉护理（MAC）进行肾下腹主动脉瘤腔内修复术（EVAR）的结局。2005年至2008年期间进行的择期腹主动脉瘤腔内修复术病例是使用当前手术术语代码从美国外科医师学会国家外科手术质量改进项目数据库中识别的。排除了紧急病例和需要全身麻醉的伴随手术的患者。检查患者水平的合并症、特征以及术中和术后详情。对并发症进行了单独和汇总分析，包括伤口、肺、肾、静脉血栓栓塞、心血管、手术和脓毒症。住院时间（LOS）和30天死亡率进行了检查。使用平均值±标准差或计数（%）描述特征和结局，并使用χ2、Fisher精确检验和单变量线性回归评价比较的统计学显著性。使用对数转换，采用线性回归技术分析LOS。使用单变量和多变量回归技术检查麻醉类型和结局之间的关系。我们确定了6009例择期腹主动脉瘤腔内修复术进行分析。全麻4868例，腰麻419例，硬膜外麻醉331例，局麻/MAC 391例。11%的患者发生了明确的发病率。中位LOS为2（四分位距，1-3）天，平均LOS为2.8 ± 4.3天。30天死亡率为1.1%。麻醉类型、肺部发病率和log-LOS之间存在显著的多变量相关性。全身麻醉与肺部发病率的增加相关（比值比[OR]，4.0; 95%置信区间[CI]，1.3-12.5; P = 0.020）和局部/MAC麻醉（OR，2.6; 95% CI，1.0-6.4; P = 0.041）。使用全身麻醉与全身麻醉相比，LOS增加10%（95% CI，4.8%-15.5%; P = 0.001），全身麻醉与局部/MAC麻醉相比增加20%（95% CI，14.1%-26.2%; P <0.001）。全麻与硬膜外麻醉相比，未观察到肺部发病率和LOS增加的趋势。麻醉类型与死亡率之间没有显著相关性。在当代北美麻醉和手术实践中，与脊髓和局部/MAC麻醉相比，腹主动脉瘤腔内修复术的全身麻醉与术后LOS和肺部发病率增加相关。这些数据表明，增加微创麻醉技术的使用可能会限制术后并发症并降低腹主动脉瘤腔内修复术的总成本。
This study examined outcomes of endovascular repair of infrarenal abdominal aortic aneurysms (EVAR) using general, spinal, epidural, and local/monitored anesthesia care (MAC) in a multicenter North American hospital database reflecting contemporary anesthesia and surgical practices. Elective EVAR cases performed between 2005 and 2008 were identified from the American College of Surgeons National Surgical Quality Improvement Program database using Current Procedural Terminology codes. Excluded were emergency cases and patients with concomitant procedures requiring general anesthesia. Patient-level comorbidities, characteristics, and intraoperative and postoperative details were examined. Complications were analyzed individually and in aggregate categories, including wound, pulmonary, renal, venous thromboembolic, cardiovascular, operative, and septic. Length of stay (LOS) and 30-day mortality were examined. Characteristics and outcomes were described using mean ± standard deviation or count (%), and comparisons were evaluated for statistical significance using χ2, Fisher exact test, and univariate linear regression. LOS was analyzed with linear regression techniques using a log transformation. Associations between anesthesia type and outcomes were examined using univariable and multivariable regression techniques. We identified 6009 elective EVAR procedures for analysis. General anesthesia was used in 4868 cases, spinal anesthesia in 419, epidural anesthesia in 331, and local/MAC in 391. Defined morbidity occurred in 11% of patients. Median LOS was 2 (interquartile range, 1–3) days, and mean LOS was 2.8 ± 4.3 days. The 30-day mortality rate was 1.1%. Significant multivariate associations were observed between anesthesia type, pulmonary morbidity, and log-LOS. General anesthesia was associated with an increase in pulmonary morbidity vs spinal (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.3–12.5; P = .020) and local/MAC anesthesia (OR, 2.6; 95% CI, 1.0–6.4; P = .041). Use of general anesthesia was associated with a 10% increase in LOS for general vs spinal anesthesia (95% CI, 4.8%–15.5%; P = .001) and a 20% increase for general vs local/MAC anesthesia (95% CI, 14.1%–26.2%; P < .001). Trends toward increased pulmonary morbidity and LOS were not observed for general vs epidural anesthesia. No significant association between anesthesia type and mortality was observed. In contemporary North American anesthetic and surgical practice, general anesthesia for EVAR was associated with increased postoperative LOS and pulmonary morbidity compared with spinal and local/MAC anesthesia. These data suggest that increasing the use of less-invasive anesthetic techniques may limit postoperative complications and decrease the overall costs of EVAR.