Local Versus General Anesthesia in Nonemergency Endovascular Abdominal Aortic Aneurysm Repair: A Systematic Review and Meta-Analysis.

ABSTRACT

The purpose of this systematic review was to assess the perioperative clinical outcomes in using local/regional anesthesia (LA/RA) or general anesthesia (GA) in patients undergoing endovascular abdominal aortic aneurysm repair. A comprehensive electronic literature search was undertaken from inception to September 2018, identifying all randomized and nonrandomized studies comparing LA/RA versus GA in patients with abdominal aortic aneurysm who underwent endovascular repair. A total of 12,024 patients (n = 1,664 LA/RA, n = 10,360 GA) were analyzed from 12 observational studies included in this analysis. No difference in mean age between LA/RA and GA group was noted (73.8 ± 7.8 y v 72.4 ± 7.6 y, 95% confidence interval 0.85 [-0.08 to 1.79]; p = 0.07). No differences in preoperative rate of chronic obstructive pulmonary disease, ischemic heart disease, diabetes mellitus, and American Society of Anesthesiologists grades were noted between the 2 groups (p = 0.21, p = 0.85, p = 0.46, and p = 0.67, respectively). Shorter total surgical time in LA/RA patients was reported (135 ± 40 min v 164 ± 43 min; p < 0.00001). Shorter hospital stay was observed in LA/RA patients (3.6 ± 3.3 d v 4.6 ± 5 d; p = 0.002). No difference in cardiac or renal complications was noted between the LA/RA and GA groups postoperatively (2.7% v 2.5%; p = 0.46 and 1.2% v 1.6%; p = 0.13). Similarly, no difference in vascular complications was noted in LA/RA versus GA patients (8.4% v 7.7%; p = 0.44). Thirty-day morality was not different between the 2 cohorts (2% v 1.7%; p = 0.97). Use of LA/RA in selective endovascular abdominal aortic aneurysm repair procedures provides satisfactory and comparable perioperative outcomes with those of GA, with the advantage of a shorter hospital stay. A large randomized controlled trial or multicenter study is required to confirm the present study's findings.