Your browser doesn't support javascript.
loading
General Versus Nongeneral Anesthesia for Carotid Endarterectomy: A Prospective Multicenter Registry-Based Study on 25 000 Patients.
El-Hajj, Victor Gabriel; Ghaith, Abdul Karim; Gharios, Maria; El Naamani, Kareem; Atallah, Elias; Glener, Steven; Habashy, Karl John; Hoang, Harry; Sizdahkhani, Saman; Mouchtouris, Nikolaos; Kaul, Anand; Elmi-Terander, Adrian; Tjoumakaris, Stavropoula; Gooch, M Reid; Rosenwasser, Robert H; Jabbour, Pascal.
Affiliation
  • El-Hajj VG; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm , Sweden.
  • Ghaith AK; Department of Neurological Surgery, Mayo Clinic, Rochester , Minnesota , USA.
  • Gharios M; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm , Sweden.
  • El Naamani K; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.
  • Atallah E; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.
  • Glener S; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.
  • Habashy KJ; Feinberg School of Medicine, Northwestern University, Chicago , Illinois , USA.
  • Hoang H; Department of Neurological Surgery, Mayo Clinic, Rochester , Minnesota , USA.
  • Sizdahkhani S; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.
  • Mouchtouris N; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.
  • Kaul A; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.
  • Elmi-Terander A; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm , Sweden.
  • Tjoumakaris S; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.
  • Gooch MR; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.
  • Rosenwasser RH; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.
  • Jabbour P; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.
Neurosurgery ; 95(2): 365-371, 2024 Aug 01.
Article in 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.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Postoperative Complications / Registries / Endarterectomy, Carotid / Anesthesia, General Limits: Aged / Aged80 / Female / Humans / Male / Middle aged Language: En Journal: Neurosurgery Year: 2024 Document type: Article Affiliation country:

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Postoperative Complications / Registries / Endarterectomy, Carotid / Anesthesia, General Limits: Aged / Aged80 / Female / Humans / Male / Middle aged Language: En Journal: Neurosurgery Year: 2024 Document type: Article Affiliation country: