Locoregional Anesthesia's Association With Reduced Intensive Care Unit Stay After Elective Endovascular Aneurysm Repair: Impact of Temporal Changes in Practice Patterns

• Published in: The Journal of surgical research Vol. 295; pp. 827 - 836
• Main Authors: Zottola, Zachary R., Lehane, Daniel J., Geiger, Josh T., Kruger, Joel L., Kong, Daniel S., Newhall, Karina A., Doyle, Adam J., Mix, Doran S., Stoner, Michael C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2024
• Subjects: Abdominal aortic aneurysm; Anesthesia; Anesthesia, General; Aortic Aneurysm, Abdominal - surgery; Blood Vessel Prosthesis Implantation; Endovascular Aneurysm Repair; Endovascular Procedures - methods; Humans; Intensive care unit; Intensive Care Units; Length of Stay; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Retrospective Studies; Risk Factors; Treatment Outcome; Anesthesia; Endovascular aneurysm repair; Intensive care unit; Abdominal aortic aneurysm
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2023.11.065

Elective endovascular aneurysm repair (EVAR) can be performed via local anesthetics and/or regional (epidural or spinal) anesthesia (locoregional [LR]), versus general anesthesia (GA), conferring reduced intensive care unit (ICU) and hospital stays. Current analyses fail to account for temporal changes in vascular practice. Therefore, this study aimed to confirm reductions in ICU and hospital stays among LR patients while accounting for changes in practice patterns. Using the Society for Vascular Surgery's Vascular Quality Initiative, elective EVARs from August 2003 to June 2021 were grouped into LR or GA. Outcomes included ICU admission and prolonged hospital stay (>2 d). Procedures were stratified into groups of 2 y periods, and outcomes were analyzed within each time period. Univariable and multivariate analyses were used to assess outcomes. LR was associated with reduced ICU admissions (22.3% versus 32.1%, P < 0.001) and prolonged hospital stays (14.3% versus 7.9%, P < 0.001) overall. When stratified by year, LR maintained its association with reduced ICU admissions in 2014-2015 (21.8% versus 34.0%, P < 0.001), 2016-2017 (23.6% versus 31.6%, P < 0.001), 2018-2019 (18.5% versus 30.2%, P < 0.001), and 2020-2021 (15.8% versus 28.8%, P < 0.001), although this was highly facility dependent. LR was associated with fewer prolonged hospital stays in 2014-2015 (15.6% versus 20.4%, P = 0.001) and 2016-2017 (13.3% versus 16.6%, P = 0.006) but not after 2017. GA and LR have similar rates of prolonged hospital stays after 2017, while LR anesthesia was associated with reduced rates of ICU admissions, although this is facility-dependent, providing a potential avenue for resource preservation in patients suitable for LR. [Display omitted]