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General Vs Regional Anesthesia: 30-day Outcomes Following Carotid Endarterectomy With Different Anesthesia Approaches
Pooja Desai, MD1, Paul Feustel, PhD
2, Sarah Deery, MD
3, Courtney Warner, MD
2, Kimberly Malka, MD
3, R. Clement Darling, III, MD
2.
1University of Pittsburgh Medical Center, Pittsburgh, PA, USA,
2Albany Medical Center, Albany, NY, USA,
3Maine Medical Center, Portland, ME, USA.
OBJECTIVES: Carotid endarterectomy (CEA) can reduce the risk of stroke in patients with carotid artery stenosis (CAS). The optimal anesthesia approach for CEA is debated. We studied differences in postoperative stroke, MI, in-hospital mortality, and return to OR following CEA with regional vs general anesthesia.
METHODS: De-identified data of patients who underwent CEA from 2000-2024 were obtained from the national VQI database. Patients were placed into two cohorts: regional or general anesthesia. Patient comorbidities were obtained. Operative techniques including intra-operative shunting, type of endarterectomy, patch use, and duration of surgery were measured. Symptomatic CAS was defined as preoperative transient ischemic attack, amaurosis fugax, or stroke. The Minitab software was used to perform a univariate analysis of postoperative outcomes. Binary logistic regression and multivariable analysis were used to evaluate risk-adjusted outcomes.
RESULTS: 224,641 patients underwent CEA from 2000-2024. 6.9% received regional (n=15,463) whereas 92.9% (n=208,875) received general anesthesia. The demographics between both cohorts were similar (Table 1). Conventional CEA was the most common operative approach in both groups (Table 2). The risk of postoperative stroke was low in both groups, but statistically higher with general anesthesia (1.67% vs 1.5%, p<0.001,Table 3). A similar pattern was seen with post operative MI (0.69% vs 0.46%, p<0.001, Table 3). CEA under regional anesthesia was associated with lower in-hospital mortality when compared with general after adjusting for preoperative risk factors (OR= 0.52, 95% CI 0.35-0.76, P=0.001, Table 3). There was no difference in postoperative RTOR (2 vs 2.18%, p=0.3).
CONCLUSIONS: CEA under regional anesthesia is associated with reduced postoperative stroke, MI, and in-hospital mortality when compared with general anesthesia. Both anesthesia approaches are safe with no clinically significant difference in short-term patient outcomes.
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