title: Impact of anesthesia technique on the incidence of major complications after open aortic abdominal surgery: a cohort study.
abstract: OBJECTIVE
  To determine the risk factors of perioperative complications and the impact of intrathecal morphine (ITM) in major vascular surgery.
  
  
  METHODS
  Retrospective analysis of a prospective cohort.
  
  
  METHODS
  Operating room, intensive care unit, and Postanesthesia Care Unit of a university hospital.
  
  
  METHODS
  Data from 595 consecutive patients who underwent open abdominal aortic surgery between January 1997 and December 2011 were reviewed. Data were stratified into three groups based on the analgesia technique delivered: systemic analgesia (Goup SA), thoracic epidural analgesia (Group TEA), and intrathecal morphine (Group ITM). Preoperative patient characteristics, perioperative anesthetic and medical interventions, and major nonsurgical complications were recorded.
  
  
  RESULTS
  Patients managed with ITM (n=248) and those given thoracic epidural analgesia (n=70) required lower doses of intravenous (IV) sufentanil intraoperatively and were extubated sooner than those who received systemic analgesia (n=270). Total inhospital mortality was 2.9%, and 24.4% of patients experienced at least one major complication during their hospital stay. Intrathecal morphine was associated with a lower risk of postoperative morbidity (OR 0.51, 95% CI 0.28 - 0.89), particularly pulmonary complications (OR 0.54, 95% CI 0.31 - 0.93) and renal dysfunction (OR 0.52, 95% CI 0.29 - 0.97). Other predictors of nonsurgical complications were ASA physical status 3 and 4 (OR 1.94, 95% CI 1.07 - 3.52), preoperative renal dysfunction (OR 1.61, 95% CI 1.01 - 2.58), prolonged surgical time (OR 1.78, 95% CI 1.16 - 2.78), and the need for blood transfusion (OR 1.77, 95% CI 1.05 - 2.99).
  
  
  CONCLUSIONS
  This single-center study showed a decreased risk of major nonsurgical complications in patients who received neuraxial analgesia after abdominal aortic surgery.
authors.affiliation: Department of Anesthesiology, Pharmacology and Intensive Care, Faculty of Medicine, University Hospital, CH-1211 Geneva, Switzerland. Marc-Joseph.Licker@hcuge.ch
authors.forename: Marc
authors.initials: M
authors.lastname: Licker
authors.forename: Ellenberger
authors.initials: E
authors.lastname: Christoph
authors.forename: Vanessa
authors.initials: V
authors.lastname: Cartier
authors.forename: Damiano
authors.initials: D
authors.lastname: Mugnai
authors.forename: Nicolas
authors.initials: N
authors.lastname: Murith
authors.forename: Afksendios
authors.initials: A
authors.lastname: Kalangos
authors.forename: Marc
authors.initials: M
authors.lastname: Aldenkortt
authors.forename: Tiziano
authors.initials: T
authors.lastname: Cassina
authors.forename: John
authors.initials: J
authors.lastname: Diaper
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods; D000758:Anesthesia / Q000379:methods*; D001012:Aorta, Abdominal / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D017409:Sufentanil / Q000008:administration & dosage; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*
chemical_list: D009020:Morphine; D017409:Sufentanil
keywords: Analgesia; Intrathecal morphine; Postoperative complications; Vascular surgery