Postoperative Blood Utilization In Below The Knee Amputations Is Not Influenced By Intraoperative Anesthesia
James Dittman1, Michael F. Amendola, MD2.
1VCU School of Medicine, Richmond, VA, USA, 2VA Medical Center/VCU Health System, Richmond, VA, USA.
OBJECTIVES: Large surgical database studies have indicated that the use of general anesthesia vs regional/spinal results in greater perioperative blood utilization for below the knee amputations (BKA).We sought to verify national pooled results at a single facility level using male patients undergoing BKA. METHODS: A retrospective chart review was conducted for all male patients who underwent BKA at a single Veterans Affairs Hospital from July 13, 2011 to December 12, 2014. History of hypertension, diabetes, congestive heart failure, myocardial infarction, cerebrovascular accident, COPD and renal disease, amputation or conversion, and revascularization were noted for each patient. Body mass index, pre-and post-operative pain, post-operative blood utilization, operative time, ASA level, post-operative wound complication, antiplatelet use, statin use, anticoagulation treatment and serum operative blood levels (CBC, renal panel), and mortality at 30 days, one year and two years were noted. Outcomes were followed to July 8, 2019. Of note no tourniquet was utilized during this time period for these BKA procedures. Students t-test* and Fisher’s Exact test** were applied to compare patients who received general anesthesia (GA) versus spinal/regional anesthesia (S/RA). RESULTS: During the study period, 54 patients underwent BKA procedures. GA and s/RA groups were not significantly different with respect to patient comorbidities, serum lab values or mortality (at 30 days, 1 year nor 2 years). There was no significant difference between GA and S/RA patients with regards to BKA revision frequency (38% v. 43%;p=0.8**) where 12% and 17% respectively resulted in a higher level amputation respectively. There was also no significant difference between GA and S/RA patients in subsequent contra-lateral amputation (40% v. 36%;p=1.0), pre-operative pain (71% v. 82% p=0.4**), post-operative pain (26% v. 43%;p=0.2**), post-operative MI admission (16% v. 4%;p=0.2**) nor post-operative wound infections (10% v. 30%;p=0.07**) respectively. CONCLUSIONS: In a small cohort of patients undergoing BKA, intraoperative anesthesia type was not found to impact postoperative blood utilization, other morbidities nor mortality rates. It is unclear why operative times were increased in the GA group. It is crucial that vascular surgery practices examine their own local outcomes compared to large quality database studies in guiding clinical management. 
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