Less invasive anesthetic techniques may limit postoperative complications in EVAR patients

A new study indicates that using less invasive spinal, epidural and local/monitored anesthesia care (MAC) is better than general anesthesia for elective endovascular repair of infrarenal abdominal aortic aneurysms (EVAR). Details of the research have been published in the November issue of the Journal of Vascular Surgery®, the official publication of the Society for Vascular Surgery®.

"In our study, general anesthesia was associated with increased postoperative length of stay (LOS) and increased pulmonary morbidity when compared to the other anesthetic methods," said co-author Matthew S. Edwards, associate professor of vascular and endovascular surgery at Wake Forest Baptist Medical Center in Winston-Salem, NC.

Data was collected from 2005 to 2008 using the American College of Surgeons National Surgical Quality Improvement Program database using Current Procedural Terminology codes. A total of 221 North America hospitals were included and a total of 6,009 elective EVAR cases performed. General anesthesia was used in 4,868 cases, while 419 patients had spinal anesthesia; 331 had epidural anesthesia; 391 had local/MAC. Emergency cases and patients with concomitant procedures requiring general anesthesia had been excluded from the study.

Procedural specifics varied according to anesthesia type in operative time, surgeon specialty, involvement of a surgical resident and the need for transfusion. The major end points evaluated in this investigation were mortality, morbidity and LOS. The 30-day mortality rate was 1.1 percent. Defined morbidity occurred in 11 percent of patients. Median LOS was 2 (interquartile range, 1-3) days and mean LOS was 2.8-4.3 days.

General anesthesia was associated with an increase in pulmonary morbidity vs. spinal (odds ratio [OR], 4.0 and 95 percent confidence interval [CI], 1.3-12.5), and local/MAC anesthesia (OR, 2.6; 95 percent CI, 1.0-6.4). Use of general anesthesia also was associated with a 10 percent increase in LOS for general vs. spinal anesthesia (95 percent CI, 4.8 percent-15.5 percent), and a 20 percent increase for general vs. local/MAC anesthesia (95 percent CI, 14.1 percent-26.2 percent). Trends toward increased pulmonary morbidity and LOS were not observed for general vs. epidural anesthesia. No significant association between anesthesia type and mortality was observed.

"Our study data suggest that increasing the use of less invasive anesthetic techniques may limit postoperative complications and decrease overall costs of care in EVAR patients," said Dr. Edwards. "The findings also suggest that use of a local anesthesia/MAC or spinal anesthesia for EVAR reduces pulmonary morbidity and length of stay."