[Local Versus General Anaesthesia for Carotid Surgery: a Multicentre Study Matched by Propensity Score]

Carotid endarterectomy (CEA) was performed under either local anaesthesia (LA) or general anaesthesia (GA) in patients with carotid artery stenosis. The perioperative outcome after 30 days was investigated using propensity score matching.

In this retrospective multicentre study, 1966 patients with symptomatic (37.9%) and asymptomatic (62.1%) carotid stenosis from eight German vascular surgery centres were included. Procedures were performed under LA in 918 cases (46.7%) and under GA in 1,048 cases (53.3%). After propensity score matching, 836 patients remained in each group (LA and GA).

In the unadjusted analysis, no significant differences were found in postoperative complications (LA vs. GA: death 0.7% in both groups; stroke 1.3% vs. 1.7%; myocardial infarction 0.6% vs. 0.3%; major adverse cardiovascular events [MACE] 2.9% vs. 2.3%). Multivariate analysis likewise showed no significant difference in the risk of major complications (stroke, myocardial infarction, death, reoperation) for LA compared with GA (OR: 1.17 [95% CI: 0.65-2.10]; p = 0.596). There was also no statistically significant difference for minor complications (haematoma, cranial nerve injury, restenosis; OR: 1.30 [95% CI: 0.70-2.42]; p = 0.401). Postoperative length of hospital stay (mean 4.7 ± 3.0 days) did not differ between groups. In the matched overall cohort, age > 80 years was associated with an increased risk of major complications (OR: 1.65 [95% CI: 1.05-2.59]; p = 0.030). For minor complications, male sex was associated with a significantly lower risk (OR: 0.69 [95% CI: 0.49-0.96]; p = 0.027), as was symptomatic stenosis (OR: 0.59 [95% CI, 0.42-0.83]; p = 0.003). Longer operative time, however, was associated with an increased risk (per 10 min: OR: 1.08 [95% CI: 1.03-1.14]; p = 0.004). The type of anaesthesia (local vs. general) was not significantly associated with the occurrence of complications in either model.

This study supports current guideline recommendations to base the choice of anaesthesia for CEA on the experience of the surgeon and anaesthesiologist as well as on patient preference.