Locoregional Versus General Anesthesia in Prolonged Carotid Endarterectomy: A Propensity Score-Matched Study from the American College of Surgeons National Surgical Quality Improvement Program Database from 2011 to 2022

Document Type

Journal Article

Publication Date

1-1-2025

Journal

Annals of vascular surgery

Volume

110

Issue

Pt A

DOI

10.1016/j.avsg.2024.09.053

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 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP)-targeted database from 2011 to 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 preoperative differences between patients under locoregional and general anesthesia to assess 30-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. CONCLUSIONS: 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.

Department

Surgery

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