The effect of mode of anaesthesia on outcomes after elective endovascular repair of abdominal aortic aneurysm

George Dovell*, Chris A Rogers, Richard Armstrong, Rosie A Harris, Robert J Hinchliffe, Ronelle Mouton

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

Background:
Endovascular aneurysm repair (EVAR) is the most commonly used method to repair abdominal aortic aneurysm. EVAR can be performed using a variety of anaesthetic techniques including general anaesthetic (GA), regional anaesthetic (RA) and local anaesthetic (LA) but little is known about the effect each of these anaesthetic modes have on patient outcome.

Methods:
Data from the United Kingdom National Vascular Registry were analysed. All patients undergoing elective, standard infra-renal EVAR between 1st January 2014 and the 31st December 2016 were included. Patients with a symptomatic aneurysm treated semi-electively were excluded. The primary outcome was in-hospital death within 30-days of surgery. Secondary outcomes included postoperative complications and length of hospital stay. Time-toevent outcomes were compared using Cox Proportional Hazards regression adjusted for confounders including British Aneurysm Repair score and chronic lung disease.

Results:
A total of 9783 patients received an elective, standard infra-renal EVAR (GA n=7069, RA n=2347 and LA n=367) across 89 hospitals. RA and/or LA was used in 82 hospitals. There were 64 in-hospital deaths within 30-days, 50 (0.9% mortality at 30days, 95% confidence interval [0.7%, 1.2%]) GA, 11 (0.6% [0.3%, 1.1%]) RA and 3 (1.5% [0.5%, 4.7%]) LA. The mortality was significantly lower in the RA group compared to the GA group (adjusted hazard ratio RA/GA: 0.37 [0.17,0.81] (p=0.03); LA/GA: 0.63 [0.15, 2.69]). Median length of stay was 2 days, but patients were discharged from hospital more quickly in the RA and LA groups compared to the GA (adjusted hazard ratio RA/GA: 1.10 [1.03, 1.17]; LA/GA: 1.15 [1.02, 1.29]). Pulmonary complications occurred with similar frequency (overall 2.4%, adjusted odds ratio RA/GA: 0.93 [0.66, 1.32]; LA/GA: 0.82 [0.41, 1.63]).

Conclusion:
30-day mortality was lower with RA compared to GA, but mode of anaesthesia was not associated with increased complications for patients undergoing elective, standard infra-renal EVAR
Original languageEnglish
JournalEuropean Journal of Vascular and Endovascular Surgery
Early online date11 Apr 2020
DOIs
Publication statusE-pub ahead of print - 11 Apr 2020

Structured keywords

  • BTC (Bristol Trials Centre)

Keywords

  • Abdominal aortic aneurysm
  • Anaesthesia r
  • Elective endovascular aneurysm repai

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