Effect of regional versus general anesthesia on thirty-day outcomes following carotid endarterectomy: a cohort study

Abstract

Background: The effect of regional versus general anesthesia on carotid endarterectomy outcomes is debated. This study assesses the effect of anesthetic technique on major morbidity and mortality and additional secondary endpoints following carotid endarterectomy. Materials and methods: This was a retrospective propensity-matched-cohort analysis investigating elective carotid endarterectomy patients in the 2015–2019 American College of Surgeons National Surgical Quality Improvement Program (n=37 204). The primary endpoint was 30-day mortality and major morbidity, defined as stroke, myocardial infarction, or death. Secondary endpoints included minor morbidity, bleeding events, healthcare resource utilization, and length of hospital stay. Univariate, multivariable, and survival analyses were applied. Results: The 1 : 1 propensity-matched-cohort included 8304 patients (4152 in each group). Regional anesthesia was associated with similar incidences of major morbidity and mortality [odds ratio (OR), 0.81 (95% CI, 0.61–1.09); P = 0.162] and unplanned resource utilization [OR, 0.93 (95% CI, 0.78–1.11); P = 0.443], but lower incidences of minor morbidity [OR, 0.60 (95% CI, 0.44–0.81); P < 0.001] and bleeding events [OR, 0.49 (95% CI, 0.30–0.78); P = 0.002], and a shorter length of hospital stay [1.4 vs. 1.6 days; mean difference, -0.16 days (95% CI, -0.25 to -0.07); P < 0.001]. On multivariable analysis, regional anesthesia remained independently predictive of minor morbidity [adjusted odds ratio (AOR), 0.58 (95% CI, 0.42–0.79); P = 0.001] and bleeding events [AOR, 0.49 (95% CI, 0.30–0.77); P = 0.003]. Significance was maintained on survival analysis for these two endpoints. A mortality benefit was observed on univariate [OR, 0.50 (95% CI, 0.25–1.00); P = 0.045], multivariable [AOR, 0.49 (95% CI, 0.24–0.96); P = 0.043], and survival analysis (P = 0.045). Conclusions: Carotid endarterectomy patients receiving regional anesthesia experience favorable outcomes compared to propensity-matched general anesthesia controls.