Locoregional versus general anesthesia in prolonged carotid endarterectomy: a propensity-score matched study from ACS-NSQIP database from 2011-2022

Authors

Renxi Li, The George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address: renxili@gwu.edu.
Anton Sidawy, The George Washington University Hospital, Department of Surgery, Washington, DC.
Bao-Ngoc Nguyen, The George Washington University Hospital, Department of Surgery, Washington, DC.

Document Type

Journal Article

Publication Date

10-14-2024

Journal

Annals of vascular surgery

DOI

10.1016/j.avsg.2024.09.053

Keywords

carotid endarterectomy; carotid stenosis; general anesthesia; locoregional anesthesia; prolonged

Abstract

BACKGROUND: Carotid endarterectomy (CEA) is an effective treatment for carotid stenosis. Previous studies yielded conflicting findings regarding postoperative outcomes after CEA when comparing those under general and locoregional anesthesia. However, these findings may be influenced by an inherent selection bias, as general anesthesia is frequently selected for more complex CEA. To counteract this selection bias, this study compared the 30-day outcomes of locoregional and general anesthesia in patients who underwent prolonged CEA. METHODS: Adult patients undergoing CEA were identified in ACS-NSQIP targeted database from 2011-2022. Only cases with prolonged operative times (over third quartile) were selected. Patients who had symptomatic and asymptomatic carotid stenosis were examined separately. A 1:3 propensity-score matching was used to address pre-operative differences between patients under locoregional and general anesthesia to assess thirty-day postoperative outcomes. Moreover, factors associated with prolonged CEA were identified by multivariable logistic regression. RESULTS: Among symptomatic patients who underwent prolonged CEA, 246 and 4,286 were under locoregional and general anesthesia, respectively. In asymptomatic patients, 388 had locoregional anesthesia and 5,137 had general anesthesia. After propensity-score matching, patients under locoregional and general anesthesia had comparable 30-day mortality (symptomatic: 1.63% vs 0.81%, p=0.28; asymptomatic: 0.77% vs 0.52%, p=0.70) and stroke (symptomatic: 4.88% vs 4.34%, p=0.72; asymptomatic: 1.29% vs 1.46%, p=1.00). All other 30-day outcomes were comparable between groups, except for symptomatic patients under locoregional had shorter operation time (p<0.01) and asymptomatic patients under locoregional had lower cranial nerve injury (2.06% vs 4.90%, p=0.02). High-risk anatomical factors, male sex, younger age, and certain comorbidities were associated with prolonged operative times. CONCLUSION: Patients under both types of anesthesia had mostly comparable 30-day postoperative outcomes, including mortality and stroke, for both symptomatic and asymptomatic patients. Therefore, locoregional and general anesthesia appear to be equally effective in CEA cases characterized by anticipated complexity and, consequently, prolonged operative times.

APA Citation

Li, Renxi; Sidawy, Anton; and Nguyen, Bao-Ngoc, "Locoregional versus general anesthesia in prolonged carotid endarterectomy: a propensity-score matched study from ACS-NSQIP database from 2011-2022" (2024). GW Authored Works. Paper 5837.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5837

Department

Surgery