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Anesthesia type may affect EVAR procedure time, postoperative stay
In patients undergoing endovascular aortic aneurysm repair, local or regional anesthesia may confer benefits in terms of procedure time, ICU admission and postoperative hospital stay, according to new data from the ENGAGE registry.
However, the type of anesthesia used does not appear to affect perioperative mortality or morbidity.
Researchers for the prospective, multicenter, nonrandomized registry evaluated data on 1,261 patients (mean age, 73 years) who were enrolled at 79 sites in 30 countries from March 2009 to April 2011. Patients underwent endovascular aortic aneurysm repair (EVAR) with the Endurant stent graft system (Medtronic). The researchers compared outcomes of surgery based on the type of anesthesia used, which was extracted from operation and anesthesia reports.
General anesthesia was used in 62% of patients, regional anesthesia in 27% of patients and local anesthesia in 11% of patients.
The primary outcome was 30-day morbidity and mortality. Adverse events and quality of life were defined as secondary outcome measures.
On average, an overall difference in age existed in use of general, regional and local anesthesia (P = .026). A disparity also was noted in the distribution of anesthesia type based on American Society of Anesthesiologists (ASA) classification, with ASA class 4 linked to the predominant use of general anesthesia.
Presentation of symptoms were lower in patients who received local and regional anesthesia compared with general anesthesia (P = .004). The shortest procedure time was seen with local anesthesia (80 ± 40 minutes) vs. regional anesthesia (94.2 ± 41.6 minutes; P = .001) and general anesthesia (105.3 ± 46 minutes; P < .001).
The incidence of type 1 or type 3 endoleak at completion angiography did not significantly differ among the groups, and anesthesia type did not have an impact on technical success rates. The researchers reported no intraoperative deaths. Regional anesthesia was associated with a lower prevalence of ICU admission vs. general anesthesia (adjusted OR = 0.71; 95% CI, 0.53-0.97) and local anesthesia (adjusted OR = 0.51; 95% CI, 0.33-0.79). Compared with general anesthesia, postoperative hospital stay was shorter for both regional (P = .003) and local (P = .01) anesthesia.
Systemic and surgical complications did not differ significantly between the groups.
At 30 days after the procedure, 1.4% of patients who received general anesthesia died compared with 0.9% who received regional anesthesia (adjusted OR = 1.52; 95% CI, 0.41-5.65) and 1.4% who received local anesthesia (adjusted OR = 0.91; 95% CI, 0.19-4.36). In a visual analogue scale of self-rated patient health at 30 days, there was an overall difference in favor of local anesthesia (P = .021).
“The main findings of this study were that [local anesthesia] and [regional anesthesia] had advantages compared with [general anesthesia] regarding duration of procedure and postoperative stay,” the researchers wrote. “No effects of anesthesia type on procedure success and perioperative mortality and morbidity were reported. Patients seemed to recover quicker after [local anesthesia.] Based on these results, a strategy based on preferential use of locoregional anesthesia for EVAR is advised, restricting [general anesthesia] only to those with predefined contraindication.” – by Jennifer Byrne
Disclosure: Some of the researchers report receiving contributions and research grants from Medtronic AVE or being proctors for Medtronic AVE.