Mortality And Operative Outcomes In Monitored Anesthesia Care Versus General Anesthesia For Elective Abdominal Aortic Endovascular Aneurysm Repair
Zachary R. Zottola, B.S., Daniel S. Kong, MD, Joel L. Kruger, M.P.H., Karina A. Newhall, M.D., M.S., Adam J. Doyle, MD, Doran S. Mix, MD, Michael C. Stoner, MD.
University of Rochester Medical Center, Rochester, NY, USA.
OBJECTIVES: To date, the majority of endovascular aneurysm repairs (EVAR) of abdominal aortic aneurysms (AAA) are performed under general anesthesia (GA). However, due to the minimally invasive nature of the procedure, it has been shown that monitored anesthesia care (MAC), including local and regional anesthesia, may provide an alternative anesthetic modality. The safety of MAC has largely been unstudied, especially as it relates to an elective (non-emergent) setting. The objective of our study was to analyze perioperative and postoperative outcomes comparing MAC versus GA.
METHODS: Using the VQI database we retrospectively analyzed all patients undergoing elective EVAR from January 2011- June 2021. The MAC group included both local and regional anesthesia. Patients were propensity score matched in order to balance for pertinent covariates. Primary outcomes included 30-day and 1-year mortality, postoperative complications stratified by pulmonary, cardiac, renal and vascular complications, hospital length-of-stay, days requiring intensive care, and reintervention. Secondary outcomes included operative time, time under fluoroscopy, and total contrast.
RESULTS: 4,302 repairs using MAC and 46,507 repairs using GA were found to fit our criteria. After employing propensity score matching two groups of 2,950 patients were produced. There was no significant difference in 30-day or 1-year mortality. Additionally, there was no statistically significant difference in post-operative length of stay, reoperation, any postoperative complications, or total contrast used. GA was found to be significantly associated with increased ICU length of stay (0.51±0.02 days vs. 0.39±0.03 days; <0.001), increased procedure time (123.99±1.13 min. vs. 110.59±0.98 min.; p<0.001), increased fluoroscopy time (23.57±0.36 min. vs 20.9±0.28 min.; p<0.001) and increased intraoperative complications (29.99% vs. 21.05%; p <0.001), which included completion endoleak, renal artery coverage, iliac artery injury, iliac/femoral thrombectomy or distal embolectomy.
CONCLUSIONS: Our data demonstrates that MAC can be a safe alternative to GA in patients undergoing an elective EVAR and may be a beneficial anesthetic modality in appropriate patient populations. This data further suggests MAC could become a more prevalent anesthesia modality due to the decreased hospital utilization. Furthermore, these data suggest the safety of endovascular aortic repair in a lower-acuity environment such as a catheterization suite or off site endovascular center.
Back to 2022 ePosters