General Anesthesia Associated With Increased Blood Transfusions And Multiple Complications Following Above Knee Amputation In A Large Va Cohort
James M. Dittman, BS, Wayne Tse, MD, Kedar S. Lavingia, MD, Luke Wolfe, MS, Michael F. Amendola, MD, MEHP.
Virginia Commonwealth University, Richmond, VA, USA.
No studies published to date have assessed above the knee amputation (AKA) outcomes specifically as they relate to choice of anesthesia. We set forth to investigate anesthesia-related AKA outcomes across the national veteran population utilizing the Veteran’s Affairs Surgical Quality Improvement Program (VASQIP) database.
Following IRB approval, all patients who underwent AKA from 1999 to 2018 recorded in the VASQIP database were separated by anesthesia type: general anesthesia (G-A) versus other anesthesia (regional, spinal, epidural, nerve block; O-A). Patient demographics, relevant medical history and related outcomes were recorded and compared using chi square with Yates correction. A binary logistic regression model+ was applied to generate covariate-adjusted odds ratios with 95% confidence interval (SPSS software; version 25, IBM Corp).
20,879 patients with an average age of 68.2 ± 10.5 years underwent AKA (98.8% male) during the study period. There was no significant difference in average age or ASA class between G-A and O-A. There was no significant difference between post-operative length of stay or post-operative rates of superficial or deep wound infections, wound dehiscence, CVA, PE, DVT, or progressive renal insufficiency between G-A and O-A.
When adjusted for co-variates, G-A corresponded to increased odds ratios+ for post-operative blood utilization 2.504 (1.277-4912), sepsis 1.355 (1.127-1.630), and cases with 3 or more complications 1.320 (1.073-1.625).
In a large veteran AKA cohort, slight but significant differences were found in numerous outcomes based on anesthesia use. Our results suggest post-operative transfusion and sepsis may be increased with use of general anesthesia in AKA patients specifically in the veteran population. Vascular practices and anesthesiologists should consider these trends when selecting anesthesia type for lower extremity amputations.
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