Anesthesia Techniques for Vitreoretinal Surgery in the United States: A Report from the Multicenter Perioperative Outcomes Group Research Consortium.

Autor: Chauhan MZ; From the Department of Ophthalmology, University of Arkansas for Medical Sciences (M.Z.C., A.B.S.), Little Rock, Arkansas, USA. Electronic address: MZChauhan@uams.edu., Soliman MK; Department of Ophthalmology and Visual Sciences, University Hospitals Eye Institute, Case Western Reserve University (M.K.S.), Cleveland, Ohio, USA; Department of Ophthalmology, Faculty of Medicine, Assiut University Hospitals (M.K.S.), Assiut, Egypt., Pace NL; Department of Anesthesiology, University of Utah (N.L.P.), Salt Lake City, Utah, USA., Mathis MR; Department of Anesthesiology, University of Michigan (M.R.M.), Ann Arbor, Michigan, USA., Schonberger RB; Department of Anesthesiology, Yale School of Medicine (R.B.S.), New Haven, Connecticut, USA., Sallam AB; From the Department of Ophthalmology, University of Arkansas for Medical Sciences (M.Z.C., A.B.S.), Little Rock, Arkansas, USA. Electronic address: ahmedsallam11@yahoo.com.
Jazyk: angličtina
Zdroj: American journal of ophthalmology [Am J Ophthalmol] 2024 Nov; Vol. 267, pp. 30-40. Date of Electronic Publication: 2024 Jun 12.
DOI: 10.1016/j.ajo.2024.06.010
Abstrakt: Purpose: To explore the patterns of anesthesia use and their determinants during vitreoretinal (VR) surgeries in academic and community hospitals across the US, using data from the Multicenter Perioperative Outcomes Group (MPOG).
Design: A retrospective, multicenter, cohort study.
Methods: We queried the MPOG database of 107,066 patients undergoing VR surgeries. Patients (≥18 years) undergoing VR surgery with monitored anesthesia care (MAC) or general anesthesia (GA) from January 1, 2015 to December 31, 2021 were included. Patient-level, case-based, and institutional-level covariates were collected. We performed multivariable mixed-effects models to determine predictors of anesthesia type use. The primary outcome was the type of anesthesia (MAC or GA) used during VR surgeries. As a secondary outcome, MAC cases were further classified based on the additional use of sedation into MAC with or without sedation.
Results: We found that 67.45% of VR surgery cases received MAC, and 73.63% of institutions administered MAC to more than half of cases. Random effect modeling revealed that 47.76% of the variation in MAC use was attributed to institutions. A trend toward increased use of MAC with increasing age was observed. Patients diagnosed with chronic pulmonary disease, liver disease, or a history of drug abuse were less likely to receive MAC. Conversely, we found that patients with reported alcohol abuse disorder, diabetes with complications, and those with American Society of Anesthesiologists (ASA) physical status of 4 (vs. 1, 2, or 3) were more likely to use MAC. Compared to non-complex VR surgeries, there was a notably decreased likelihood of MAC use in complex PPV (P = .004), PPV + scleral buckle (SB) for retinal detachment (P < .0001), and primary SB surgery (P < .0001).
Conclusions: Approximately 2/3 of VR anesthesia is under MAC, but GA is still preferred for SBs, complex vitrectomy, and younger patients. We show that large interinstitutional variation for using MAC in practice exists.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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