title: Regional versus general anesthesia for carotid endarterectomy: the American College of Surgeons National Surgical Quality Improvement Program perspective.
abstract: BACKGROUND
  The ideal anesthetic technique for carotid endarterectomy remains a matter of debate. This study used the American College of Surgeons National Surgical Quality Improvement Program to evaluate the influence of anesthesia modality on outcomes after carotid endarterectomy.
  
  
  METHODS
  Postoperative outcomes were compared for American College of Surgeons National Surgical Quality Improvement Program patients undergoing carotid endarterectomy between 2005 and 2009 with either general or regional anesthesia. A separate analysis was performed on a subset of patients matched on propensity for undergoing carotid endarterectomy with regional anesthesia.
  
  
  RESULTS
  For the entire sample of 24,716 National Surgical Quality Improvement Program patients undergoing carotid endarterectomy and the propensity-matched cohort of 8,050 patients, there was no difference in the 30-day postoperative composite stroke/myocardial infarction/death rate based on anesthetic type. Within the matched cohort, the rate of other complications did not differ (2.8% regional vs. 3.6% general anesthesia; P = .07), but patients receiving regional anesthesia had shorter operative (99 ± 36 minutes vs 119 ± 53 minutes; P < .0001) and anesthesia times (52 ± 29 minutes vs. 64 ± 37 minutes; P < .0001) and were more likely to be discharged the next day (77.0% vs 64.4%; P < .0001).
  
  
  CONCLUSIONS
  Anesthesia technique does not impact patient outcomes after carotid endarterectomy, but may influence overall cost of care.
authors: Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA. matthew.schechter@duke.edu
authors: Matthew A
authors: MA
authors: Schechter
authors: Cynthia K
authors: CK
authors: Shortell
authors: John E
authors: JE
authors: Scarborough
mesh_terms: D000368:Aged; D000765:Anesthesia, Conduction; D000768:Anesthesia, General; D015331:Cohort Studies; D016894:Endarterectomy, Carotid / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality*; D015397:Program Evaluation; D058996:Quality Improvement / Q000706:statistics & numerical data*; D020521:Stroke / Q000401:mortality*; D015996:Survival Rate; D016896:Treatment Outcome