Use of local anesthesia during percutaneous EVAR is associated with fewer pulmonary complications
Kathryn Van Orden, M.D., Alik Farber, M.D., Marc L. Schermerhorn, M.D., Jeffrey A. Kalish, M.D., Denis Rybin, Ph.D., Gheorghe Doros, Ph.D., Sevan Komshian, M.S., Jeffrey J. Siracuse, M.D..
Boston University, Boston, MA, USA.
OBJECTIVES: Percutaneous endovascular aortic aneurysm repair (pEVAR) can be performed using general or local anesthesia. Or goal was to evaluate the effect of anesthesia type on pEVAR.
METHODS: The Vascular Quality Initiative database was queried for all pEVAR procedures. Univariable analysis was used to compare pEVAR cohorts treated using general and local anesthesia and multivariable analysis was used to determine the independent effect of anesthesia type.
RESULTS: 4860 pEVAR procedures were identified in the database with local or general anesthesia. Mean patient age was 73 and 82.7% were male. General and local anesthesia was used in 4416 (90.9%) and 444 (9.1%) of cases, respectively. Patients undergoing EVAR under local anesthesia were more likely to be older (74.7% vs. 72.9%), non-Caucasian (82.4% vs. 89.1%), have lower BMI (27.3 vs. 28.4) not have Medicare (61.6% vs. 63.2%), and have a lower rate of previous lower extremity bypass (3.8% vs. 4.7%). They were also less likely to have an elective repair (83.8% vs. 86.2%), have higher rates of congestive heart failure (17.6% vs. 12.1%), less likely to be on preoperative anticoagulation (15.8% vs. 10.7%) and more likely to have their access with ultrasound guidance (87.4 vs. 78.5%) (P<.01). Anesthesia type did not affect 30 day mortality, cardiac complications, stroke, and hospital and ICU length of stay (LOS). Local anesthesia was associated with shorter procedural time (108.2 +/- 48 vs. 117 +/- 61 minutes, P=.002) and lower postoperative respiratory complications (1.1% vs. 2.7%, P=.043). Multivariate analysis showed local anesthesia to be independently associated with lower respiratory complications (OR 0.27, 95% CI 0.11-0.69, P=.006) and shorter operative time (MR 0.89, 95% CI 0.85-0.93, P<.001).
CONCLUSIONS: Local anesthesia was associated with fewer pulmonary complications for percutaneous EVAR and should be the anesthesia of preference when possible.
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