General Versus Nongeneral Anesthesia for Carotid Endarterectomy: A Prospective Multicenter Registry-Based Study on 25 000 Patients.
Neurosurgery
; 95(2): 365-371, 2024 Aug 01.
Article
em En
| MEDLINE
| ID: mdl-38391204
ABSTRACT
BACKGROUND AND OBJECTIVES:
Carotid endarterectomy (CEA) is a well-established treatment option for carotid stenosis. The choice between general anesthesia (GA) and nongeneral anesthesia (non-GA) during CEA remains a subject of debate, with concerns regarding perioperative complications, particularly myocardial infarctions. This study aimed to evaluate the outcomes associated with GA vs non-GA CEA using a large, nationwide database.METHODS:
The National Surgical Quality Improvement Project database was queried for patients undergoing CEA between 2013 and 2020. Primary outcome measures including surgical outcomes and 30-day postoperative complications were compared between the 2 anesthesia methods, after 21 propensity score matching.RESULTS:
After propensity score matching, a total of 25 356 patients (16 904 in the GA and 8452 in the non-GA group) were included. Non-GA compared with GA CEA was associated with significantly shorter operative times (101.9, 95% CI 100.5-103.3 vs 115.8 95% CI 114.4-117.2 minutes, P < .001), reduced length of hospital stays (2.3, 95% CI 2.15-2.4 vs 2.5, 95% CI 2.4-2.6 days, P < .001), and lower rates of 30-day postoperative complications, including myocardial infarctions (0.8% vs 1.2%, P = .003), unplanned intubations (0.8% vs 1.1%, P = .016), pneumonia (0.5% vs 1%, P < .001), and urinary tract infections (0.4% vs 0.7%, P = .003). These outcomes were notably more pronounced in the younger (≤70 years) and high morbidity (American Society of Anesthesiologists 3-5) cohorts.CONCLUSION:
In this nationwide registry-based study, non-GA CEA was associated with better short-term outcomes in terms of perioperative complications, compared with GA CEA. The findings suggest that non-GA CEA may be a safer alternative, especially in younger patients and those with more comorbidities.
Texto completo:
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Bases de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Sistema de Registros
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Endarterectomia das Carótidas
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Anestesia Geral
Limite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Neurosurgery
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Suécia