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The study of transcarotid artery revascularization under local versus general anesthesia with results from the Society for Vascular Surgery Vascular Quality Initiative
Vascular ( IF 1.1 ) Pub Date : 2020-05-14 , DOI: 10.1177/1708538120924158
Dipankar Mukherjee 1 , Devon T Collins 2 , Chang Liu 1 , Neul Ha 1 , Jeffrey Jim 3
Affiliation  

Objective The primary purpose of this study was to examine any potential difference in clinical outcomes between transcarotid artery revascularization performed under local anesthesia compared with general anesthesia by utilizing a large national database. Methods The primary outcome of the study was a composite endpoint of postoperative in-hospital stroke, myocardial infarction and mortality following transcarotid artery revascularization for the index procedure. Secondary outcomes included a composite outcome of postoperative in-hospital stroke, transient ischemic attack, myocardial infarction and mortality along with several subsets of its components and each individual component, flow reversal time (min), radiation dose (GY/cm2), contrast volume utilized (mL), total procedure time (min), extended total length of stay (>1 day) and extended postoperative length of stay (>1 day). Statistical analyses employed both descriptive measures to characterize the study population and analytic measures such as multivariable mixed-effect linear and logistic regressions using both unmatched and propensity-score matched cohorts. Results A total of 2609 patients undergoing transcarotid artery revascularization between the years 2016 and 2018 in the US were identified, with 82.3% performed under general anesthesia and 17.7% under local anesthesia. The primary composite outcome was observed in 2.3% of general anesthesia patients versus 2.6% of local anesthesia patients (p = 0.808). The rate of postoperative transient ischemic attack and/or myocardial infarction was 1.6% with general anesthesia versus 1.1% with local anesthesia (p = 0.511). For adjusted regression analysis, general anesthesia and local anesthesia were comparable in terms of primary outcome (OR: 0.72; 95% CI: 0.27–1.93, p = 0.515). As for the secondary outcomes, no significant differences were found except for contrast, where the results demonstrated significantly less need for contrast with procedures performed under general anesthesia (coefficient: 4.94; 95% CI: 1.34–8.54, p = 0.007). A trend towards significance was observed for lower rate of postoperative transient ischemic attack and/or myocardial infarction (OR: 0.33; 95% CI: 0.09–1.18, p = 0.088) and lower flow reversal time under local anesthesia (coefficient: –0.94: 95% CI: –2.1–0.22, p = 0.111). Conclusions Excellent outcomes from transcarotid artery revascularization for carotid stenosis were observed in the VQI database between the years 2016 and 2018, under both local anesthesia and general anesthesia. The data demonstrate the choice of anesthesia for transcarotid artery revascularization does not appear to have any effect on clinical outcomes. Surgical teams should perform transcarotid artery revascularization under the anesthesia type they are most comfortable with.

中文翻译:

局部麻醉与全身麻醉下经颈动脉血运重建的研究,结果来自血管外科协会血管质量倡议

目的 本研究的主要目的是利用大型国家数据库,检查在局部麻醉下进行的经颈动脉血运重建与全身麻醉之间临床结果的潜在差异。方法 该研究的主要结果是术后院内卒中、心肌梗塞和指数手术经颈动脉血运重建术后死亡率的复合终点。次要结局包括术后院内卒中、短暂性脑缺血发作、心肌梗死和死亡率的复合结局及其组成部分的几个子集和每个独立组成部分、逆流时间(分钟)、辐射剂量(GY/cm2)、造影剂体积已使用 (mL)、总手术时间 (min)、延长的总住院时间 (> 1 天)和延长术后住院时间(> 1 天)。统计分析采用描述性措施来表征研究人群和分析措施,例如使用不匹配和倾向得分匹配的队列的多变量混合效应线性和逻辑回归。结果 2016-2018年美国共纳入2609例经颈动脉血运重建术患者,其中82.3%在全身麻醉下进行,17.7%在局麻下进行。全身麻醉患者的主要复合结局为 2.3%,局部麻醉患者为 2.6%(p = 0.808)。全身麻醉的术后短暂性脑缺血发作和/或心肌梗塞的发生率为 1.6%,而局部麻醉为 1.1% (p = 0.511)。对于调整后的回归分析,全身麻醉和局部麻醉在主要结果方面具有可比性(OR:0.72;95% CI:0.27-1.93,p = 0.515)。至于次要结果,除了对比剂外,没有发现显着差异,结果表明,与全身麻醉下进行的手术相比,对比剂的需要显着减少(系数:4.94;95% CI:1.34-8.54,p = 0.007)。观察到术后短暂性脑缺血发作和/或心肌梗死发生率较低(OR:0.33;95% CI:0.09–1.18,p = 0.088)和局部麻醉下血流逆转时间较短(系数:–0.94: 95% CI:–2.1–0.22,p = 0.111)。结论 在 2016 年至 2018 年期间,VQI 数据库中观察到经颈动脉血运重建治疗颈动脉狭窄的良好结果,在局部麻醉和全身麻醉下。数据表明,经颈动脉血运重建的麻醉选择似乎对临床结果没有任何影响。手术团队应在他们最熟悉的麻醉类型下进行经颈动脉血运重建。
更新日期:2020-05-14
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