Practice Variations in Anesthesia for Carotid Endarterectomies and Associated Outcomes

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• 作者：Rodney A. Gabriel ; MD^* ; Allyson Lemay ; MD^* ; Sascha S. Beutler ; MD ; PhD^* ; Richard P. Dutton ; MD ; MBA^&dagger ; ; Richard D. Urman ; MD ; MBA^* ; ^{rurman@partners.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：carotid endarterectomy ; general anesthesia ; regional anesthesia ; outcomes ; complications
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：30
• 期：1
• 页码：23-29
• 全文大小：414 K

文摘

The authors’ aim was to assess practice variations in anesthesia for carotid endarterectomies (CEA) and report outcomes.

Design

A retrospective cohort study.

Setting

A multi-institutional setting.

Participants

Patients who underwent CEA.

Interventions

None.

Measurements and Main Results

Using the National Anesthesia Clinical Outcomes Registry of the Anesthesia Quality Institute, CEAs performed from 2010 to 2014 were identified, and a logistic regression model was fitted to determine if various patient, intraoperative, and provider characteristics were associated with usage of regional anesthesia (RA) versus general anesthesia (GA) (primary outcome) as the primary anesthetic in CEAs. The majority of CEAs were performed under GA (31,003 GA v 1,968 RA). American Society of Anesthesiologists class III-V patients were more likely to receive RA than class I-II (odds ratio 1.63, 95% confidence interval 1.39-1.91). Also, board certification status was associated with utilization of RA (odds ratio 2.95, 95% confidence interval 2.59-3.36). Among various facility types, community hospitals had the highest rates of RA use for CEAs. Secondary outcomes studied included extended recovery room stay, unexpected intensive care admissions, inadequate pain control, and postoperative nausea/vomiting. The usage of RA over GA was associated only with decreased postoperative nausea/vomiting.

Conclusions

This study was the first to use the National Anesthesia Clinical Outcomes Registry to evaluate practice trends in the utilization of RA versus GA in CEAs. Patient comorbidities, as well as type of anesthesia provider, were associated with the usage of RA.