title: Practice Variations in Anesthesia for Carotid Endarterectomies and Associated Outcomes.
abstract: OBJECTIVE
  The authors' aim was to assess practice variations in anesthesia for carotid endarterectomies (CEA) and report outcomes.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  A multi-institutional setting.
  
  
  METHODS
  Patients who underwent CEA.
  
  
  METHODS
  None.
  
  
  RESULTS
  Using the National Anesthesia Clinical Outcomes Registry of the Anesthesia Quality Institute, CEAs performed from 2010 to 2014 were identified, and a logistic regression model was fitted to determine if various patient, intraoperative, and provider characteristics were associated with usage of regional anesthesia (RA) versus general anesthesia (GA) (primary outcome) as the primary anesthetic in CEAs. The majority of CEAs were performed under GA (31,003 GA v 1,968 RA). American Society of Anesthesiologists class III-V patients were more likely to receive RA than class I-II (odds ratio 1.63, 95% confidence interval 1.39-1.91). Also, board certification status was associated with utilization of RA (odds ratio 2.95, 95% confidence interval 2.59-3.36). Among various facility types, community hospitals had the highest rates of RA use for CEAs. Secondary outcomes studied included extended recovery room stay, unexpected intensive care admissions, inadequate pain control, and postoperative nausea/vomiting. The usage of RA over GA was associated only with decreased postoperative nausea/vomiting.
  
  
  CONCLUSIONS
  This study was the first to use the National Anesthesia Clinical Outcomes Registry to evaluate practice trends in the utilization of RA versus GA in CEAs. Patient comorbidities, as well as type of anesthesia provider, were associated with the usage of RA.
authors.affiliation: Department and Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: Rodney A
authors.initials: RA
authors.lastname: Gabriel
authors.affiliation: Department and Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: Allyson
authors.initials: A
authors.lastname: Lemay
authors.affiliation: Department and Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: Sascha S
authors.initials: SS
authors.lastname: Beutler
authors.affiliation: Anesthesia Quality Institute, American Society of Anesthesiologists, Schaumburg, IL.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Dutton
authors.affiliation: Department and Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA. Electronic address: rurman@partners.org.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Urman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000765:Anesthesia, Conduction / Q000379:methods* / Q000639:trends; D000768:Anesthesia, General / Q000379:methods* / Q000639:trends; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016894:Endarterectomy, Carotid / Q000379:methods* / Q000639:trends; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: carotid endarterectomy; complications; general anesthesia; outcomes; regional anesthesia