Effects of Anesthesia Type on Perioperative Outcome After Endovascular Aneurysm Repair.
OBJECTIVE
To examine outcomes of endovascular aortic aneurysm repair (EVAR) using general, regional, or local anesthesia.


METHODS
From March 2009 to April 2011, patients were enrolled from 79 sites in 30 countries worldwide and treated with an Endurant Stent Graft System. Data were compared among 3 groups based on the method of anesthesia: general anesthesia (GA) was used in 785 (62%) patients, regional anesthesia (RA) in 331 (27%) patients, and local anesthesia (LA) in 145 (11%) patients. Multivariate logistic regression analysis was performed to adjust for possible confounding factors; outcomes are presented as the odds ratio and 95% confidence interval.


RESULTS
There were intercontinental differences in the distribution of type of anesthesia used for EVAR. Higher ASA (American Society of Anesthesiologists) classification was associated with predominant use of GA. Procedure time was reduced in LA (80.4±40.0 minutes) compared with RA (94.2±41.6 min, adjusted p=0.001) and GA (105.3±46.0 minutes, adjusted p<0.001). Intensive care unit (ICU) admission was less frequent for RA than for GA (adjusted OR 0.71, 95% CI 0.53 to 0.97, p=0.030) and LA (adjusted OR 0.51, 95% CI 0.33 to 0.79, p=0.002). Postoperative hospital stay was significantly shorter for RA and LA compared with GA (adjusted p=0.003 and p=0.010, respectively). There were no significant differences in systemic and surgical complications. Mortality rates within 30 days did not differ among the groups.


CONCLUSIONS
Type of anesthesia used during EVAR has no influence on perioperative mortality and morbidity. The use of local or regional anesthesia during EVAR appeared to be beneficial concerning procedure time, ICU admission, and postoperative hospital stay.
Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands Department of Epidemiology, CAPHRI Research School, Maastricht University, Maastricht, The Netherlands.
Pieter P H L
PP
Broos
Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands Department of Epidemiology, CAPHRI Research School, Maastricht University, Maastricht, The Netherlands.
Rutger A
RA
Stokmans
Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Philippe W M
PW
Cuypers
Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Marc R H M
MR
van Sambeek
Joep A W
JA
Teijink
D000368:Aged; D000369:Aged, 80 and over; D000765:Anesthesia, Conduction / Q000009:adverse effects / Q000401:mortality; D000768:Anesthesia, General / Q000009:adverse effects / Q000401:mortality; D000772:Anesthesia, Local / Q000009:adverse effects / Q000401:mortality; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
abdominal aortic aneurysm; anesthesia; endovascular aneurysm repair; local anesthesia; outcome analysis