Octogenarians fare better under local anesthesia for elective endovascular aortic aneurysm repair.

OBJECTIVE: With an aging patient population, an increasing number of octogenarians are undergoing elective endovascular abdominal aortic aneurysm repair (EVAR) in the United States. Multiple studies have shown that, for the general population, use of local anesthetic (LA) for EVAR is associated with improved short-term and long-term outcomes as compared with performing these operations under general anesthesia (GA). Therefore, this study aimed to study the association of LA for elective EVARs with perioperative outcomes, among octogenarians. METHODS: The Vascular Quality Initiative database (2003-2021) was used to conduct this study. Octogenarians (Aged ≥80 years) were selected and sorted into two study groups: LA (Group I) and GA (Group II). Our primary outcomes were length of stay and mortality. Secondary outcomes included operative time, estimated blood loss, return to operating room, cardiopulmonary complications, and discharge location. RESULTS: Of the 16,398 selected patients, 1197 patients (7.3%) were included in Group I, and 15,201 patients (92.7%) were in Group II. Procedural time was significantly shorter for the LA group (114.6 vs 134.6; P < .001), as was estimated blood loss (152 vs 222 cc; P < .001). Length of stay was significantly shorter (1.8 vs 2.6 days; P < .001), and patients were more likely to be discharged home (LA 88.8% vs GA 86.9%; P = .036) in the LA group. Group I also experienced fewer pulmonary complications; only 0.17% experienced pneumonia and 0.42% required ventilator support compared with 0.64% and 1.02% in Group II, respectively. This finding corresponded to fewer days in the intensive care unit for Group I (0.41 vs 0.69 days; P < .001). No significant difference was seen in 30-day mortality cardiac, renal, or access site-related complications. Return to operating room was also equivocal between the two groups. Multivariate regression analysis confirmed GA was associated with a significantly longer length of stay and significantly higher rates of non-home discharge (adjusted odds ratio [AOR], 1.59; P < .001 and AOR, 1.40; P = .025, respectively). When stratified by the New York Heart Association classification system, classes I, II, III, and IV (1.55; P < .001; 1.26; P = .029; 2.03; P < .001; 4.07; P < .001, respectively) were associated with significantly longer hospital stays. CONCLUSIONS: The use of LA for EVARs in octogenarians is associated with shorter lengths of stay, fewer respiratory complications, and home discharge. These patients also experienced shorter procedure times and less blood loss. There was no statistically significant difference in 30-day mortality, return to operating room, or access-related complications. LA for octogenarians undergoing EVAR should be considered more frequently to shorten hospital stays and decrease complication rates.

A triangulation model for assessment of change in classroom behavior of medical teachers participating in faculty development program on lecturing skills.

BACKGROUND & AIMS: We utilized a triangulation method of a faculty development program's (FDP) evaluation comprising short-course workshops on classroom behaviors and lecturing skills of basic sciences faculty in a medical school. METHODS & RESULTS: This study utilized data from the pre and post evaluation of classroom lectures by an expert observer. Course participants were observed before the inception of a 4-month FDP and after 6-months of program completion. Findings at 6-month post-FDP interval were supplemented with students' and participant's self-evaluation. Expert evaluation of 15 participants showed that more participants were summarizing lectures at the end of their class (p = 0.021), utilizing more than one teaching tool (p = 0.008) and showing a well-structured flow of information (p = 0.013). Among the students, majority (95.5%, n = 728) agreed on "teachers were well-prepared for the lecture", however, a low number (66.1%, n = 504) agreed on "teachers were able to make the lecture interesting". On self-evaluation (n = 12), majority of the participants (91.7%, n = 11) thought these FDP workshops had a positive impact on their role as a teacher. CONCLUSIONS: Gathering feedback from multiple sources can provide a more holistic insight into the impact of an FDP and can provide a robust framework for setting up future FDP targets.