Is General Anesthesia for Peripheral Vascular Surgery Correlated with Impaired Outcome in Patients with Cardiac...

Area of Science:

• Anesthesiology
• Vascular Surgery
• Cardiology

Background:

• General anesthesia (GA) may negatively impact outcomes in vascular surgery patients.
• Patients with cardiac comorbidities often use anticoagulant medications, complicating regional anesthesia (RA) planning.
• RA requires careful management of anticoagulation before neuraxial blockade.

Purpose of the Study:

• To investigate the effect of anesthesia choice (GA vs. RA) on patient outcomes after lower extremity vascular surgery.
• To compare postoperative complications and 30-day mortality between GA and RA in patients with cardiac comorbidities.

Main Methods:

• Retrospective cohort study involving 6302 patients with cardiac comorbidities undergoing lower extremity vascular surgery.
• Data collected from Danish national registries between 2005 and 2017.
• Multivariable regression models analyzed postoperative complications and 30-day mortality, comparing GA (defined as anesthesia with mechanical ventilation) and RA.

Main Results:

• The use of RA decreased from 48% to 20% between 2005 and 2017.
• Patients receiving GA had higher rates of complications (9.7% vs. 6.2%, p < 0.001) and 30-day mortality (6.0% vs. 3.4%, p < 0.001) compared to RA.
• Adjusted analysis showed RA was associated with significantly lower odds of medical complications (OR, 0.97; 95% CI, 0.95-0.98) and 30-day mortality (OR 0.98; 95% CI, 0.97-0.99).

Conclusions:

• Regional anesthesia (RA) appears to be associated with better outcomes compared to general anesthesia (GA) in lower extremity vascular surgery patients with cardiac comorbidities.
• Despite challenges with anticoagulant management, prioritizing RA may be beneficial for this patient group.
• Further research may support RA as a preferred anesthetic technique for selected vascular surgery patients with cardiac conditions.