General Versus Nongeneral Anesthesia for Carotid Endarterectomy: A Prospective Multicenter Registry-Based Study on 25 000 Patients.

Autor:	El-Hajj VG; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm , Sweden., Ghaith AK; Department of Neurological Surgery, Mayo Clinic, Rochester , Minnesota , USA., Gharios M; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm , Sweden., El Naamani K; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA., Atallah E; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA., Glener S; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA., Habashy KJ; Feinberg School of Medicine, Northwestern University, Chicago , Illinois , USA., Hoang H; Department of Neurological Surgery, Mayo Clinic, Rochester , Minnesota , USA., Sizdahkhani S; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA., Mouchtouris N; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA., Kaul A; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA., Elmi-Terander A; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm , Sweden., Tjoumakaris S; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA., Gooch MR; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA., Rosenwasser RH; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA., Jabbour P; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia , Pennsylvania , USA.
Jazyk:	angličtina
Zdroj:	Neurosurgery [Neurosurgery] 2024 Aug 01; Vol. 95 (2), pp. 365-371. Date of Electronic Publication: 2024 Feb 23.
DOI:	10.1227/neu.0000000000002887
Abstrakt:	Background and Objectives: Carotid endarterectomy (CEA) is a well-established treatment option for carotid stenosis. The choice between general anesthesia (GA) and nongeneral anesthesia (non-GA) during CEA remains a subject of debate, with concerns regarding perioperative complications, particularly myocardial infarctions. This study aimed to evaluate the outcomes associated with GA vs non-GA CEA using a large, nationwide database. Methods: The National Surgical Quality Improvement Project database was queried for patients undergoing CEA between 2013 and 2020. Primary outcome measures including surgical outcomes and 30-day postoperative complications were compared between the 2 anesthesia methods, after 2:1 propensity score matching. Results: After propensity score matching, a total of 25 356 patients (16 904 in the GA and 8452 in the non-GA group) were included. Non-GA compared with GA CEA was associated with significantly shorter operative times (101.9, 95% CI: 100.5-103.3 vs 115.8 95% CI: 114.4-117.2 minutes, P < .001), reduced length of hospital stays (2.3, 95% CI: 2.15-2.4 vs 2.5, 95% CI: 2.4-2.6 days, P < .001), and lower rates of 30-day postoperative complications, including myocardial infarctions (0.8% vs 1.2%, P = .003), unplanned intubations (0.8% vs 1.1%, P = .016), pneumonia (0.5% vs 1%, P < .001), and urinary tract infections (0.4% vs 0.7%, P = .003). These outcomes were notably more pronounced in the younger (≤70 years) and high morbidity (American Society of Anesthesiologists 3-5) cohorts. Conclusion: In this nationwide registry-based study, non-GA CEA was associated with better short-term outcomes in terms of perioperative complications, compared with GA CEA. The findings suggest that non-GA CEA may be a safer alternative, especially in younger patients and those with more comorbidities. (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)
Databáze:	MEDLINE
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