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Carotid Endarterectomy: Gender Disparities and Anesthetic Choice Influence Outcome
Elizabeth L. Chou BS, Michael D. Sgroi MD, Isabella J. Kuo MD, Nii-Kabu Kabutey MD, Roy M. Fujitani MD, FACS.
University of California Irvine School of Medicine, Irvine, CA, USA.
OBJECTIVE
Carotid endarterectomy (CEA) is the most commonly performed surgical procedure to reduce risk of stroke. The operation may be performed under local (LA) or general anesthesia (GA). Despite perceived advantages of LA, previous trials have found no difference in rates of transient ischemic attack, stroke, myocardial infarction and death in CEA under LA compared with GA. We performed a retrospective review to see if gender may be associated with type of anesthesia and post-operative outcomes.
METHODS
Patients who underwent CEA between 2005-2011 were extracted from the National Surgical Quality Improvement Program (NSQIP). The cohort was separated by sex and anesthesia type. Primary endpoints included 30-day incidence of stroke and myocardial infarction. Secondary endpoints included 30-day postoperative local complications, operative time and length of surgical stay.
RESULTS
Of the 41,442 CEA cases identified, most patients were male (16,874 F, 24,568 M) and most cases were performed under GA (86% of female cases, 85% female cases). Adjusted multivariate analysis showed no statistical difference between primary endpoint outcomes based on gender or type of anesthesia used. There was, however, a trend for increased risk of 30-day post-operative local complications and 30 day incidence of myocardial infarction amongst CEA conducted under GA compared to LA. Operative time and length of stay was decreased in females, regardless of anesthesia used (mean difference -8.15 [10.09, -6.21] p <0.0001; 0.34 [0.14, 0.54] p <0.02). Use of general anesthesia was associated with increased operative time, and increased total length of total surgical stay, regardless of sex, with statistical significance.
CONCLUSIONS
There is no significant difference in post-operative outcomes between women and men regardless of type of anesthesia used for CEA. GA was found to be associated with increased length of stay and operative time, compared with LA in women and men. This finding suggests that choice of anesthesia may have significant economic considerations for patients and institutions. The trend of increased 30 day post-operative local complications and 30 day myocardial infarction amongst GA cases also support the use of LA for CEA. These factors warrant further evaluation to improve patient outcomes and economic impact of this commonly performed procedure.
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