Risk-adapted outcome after endovascular aortic aneurysm repair: analysis of anesthesia types based on EUROSTAR data.
OBJECTIVE
To compare anesthesia techniques in high-risk versus low-risk patients treated with endovascular aortic aneurysm repair (EVAR) with respect to outcomes.


METHODS
From July 1997 to August 2004, 5557 patients were enrolled in the EUROSTAR registry by 164 centers. Low-risk and high-risk patients were each divided into 3 groups according to anesthesia used during operation [general (GA), regional (RA), and local (LA)], resulting in 6 groups. Differences in preoperative and operative details among the 3 types of anesthesia were analyzed using a chi-square test for discrete variables and the Kruskal-Wallis test for continuous variables for each risk profile. Multivariate logistic regression analysis was performed on early complications.


RESULTS
Intensive care unit (ICU) admission was less frequent for high-LA (1.2% of patients) than high-RA (7.8%, p=0.0071) and high-GA (16.2%, p<0.0001), but high-RA still had a distinct advantage (p<0.0001) over high-GA. Systemic complications were lower both for high-LA (9.0%, p=0.0128) and for high-RA (10.7%, p<0.0001) than for high-GA (18.3%). Early death (< or =30 days) was reduced in high-RA (3.0%) versus high-GA (4.3%, p=0.0286).


CONCLUSIONS
On the basis of the EUROSTAR data, high-risk patients in particular attain important advantages from minimally invasive anesthetic techniques. Mortality, morbidity, hospital stay, and ICU admission are significantly lower for locoregional versus general anesthesia in the EUROSTAR registry. These results should encourage greater use of regional anesthesia in high-risk patients. Local anesthesia seems to be of similar benefit for EVAR in high-risk patients.
Ruppert
Volker
V
Vascular Surgery, Department of Surgery, Hospital of the Ludwig Maximilian University Munich, Campus Innenstadt, Germany. Volker.Ruppert@med.uni-muenchen.de
Leurs
Lina J
LJ
Rieger
Johannes
J
Steckmeier
Bernd
B
Buth
Jacob
J
Umscheid
Thomas
T
D000368:Aged; D000765:Anesthesia, Conduction; D000768:Anesthesia, General; D000772:Anesthesia, Local; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D018579:Patient Selection; D011183:Postoperative Complications; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D018570:Risk Assessment; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome