Short-term outcomes of combined neuraxial and general anaesthesia versus general anaesthesia alone for elective open abdominal aortic aneurysm repair: retrospective population-based cohort study

Adult Aged Aged, 80 and over Anesthesia, Epidural / methods Anesthesia, General / methods Anesthesia, Spinal / methods Anesthetics, Combined Aortic Aneurysm, Abdominal / mortality Female Humans Length of Stay / statistics & numerical data Male Middle Aged Ontario / epidemiology Postoperative Complications / mortality Retrospective Studies Treatment Outcome
abdominal aortic aneurysm neuraxial anaesthesia open aneurysm repair population-based research retrospective cohort

Journal

British journal of anaesthesia
ISSN: 1471-6771
Titre abrégé: Br J Anaesth
Pays: England
ID NLM: 0372541

Informations de publication

Date de publication:
05 2020
Historique:
received: 19 09 2019
revised: 05 01 2020
accepted: 25 01 2020
pubmed: 29 3 2020
medline: 10 5 2020
entrez: 29 3 2020
Statut: ppublish

Résumé

Use of neuraxial anaesthesia for open abdominal aortic aneurysm repair is postulated to reduce mortality and morbidity. This study aimed to determine the 90-day outcomes after elective open abdominal aortic aneurysm repair in patients receiving combined general and neuraxial anaesthesia vs general anaesthesia alone. A retrospective population-based cohort study was conducted from 2003 to 2016. All patients ≥40 yr old undergoing open abdominal aortic aneurysm repair were included. The propensity score was used to construct inverse probability of treatment weighted regression models to assess differences in 90-day outcomes. A total of 10 447 elective open abdominal aortic aneurysm repairs were identified; 9003 (86%) patients received combined general and neuraxial anaesthesia and 1444 (14%) received general anaesthesia alone. Combined anaesthesia was associated with significantly lower hazards for all-cause mortality (hazard ratio [HR]=0.47; 95% confidence interval [CI], 0.37-0.61) and major adverse cardiovascular events (HR=0.72; 95% CI, 0.60-0.86). Combined patients were at lower odds for acute kidney injury (odds ratio [OR]=0.66; 95% CI, 0.49-0.89), respiratory failure (OR=0.41; 95% CI, 0.36-0.47), and limb complications (OR=0.30; 95% CI, 0.25-0.37), with higher odds of being discharged home (OR=1.32; 95% CI, 1.15-1.51). Combined anaesthesia was also associated with significant mechanical ventilation and ICU and hospital length of stay benefits. Combined general and neuraxial anaesthesia in elective open abdominal aortic aneurysm repair is associated with reduced 90-day mortality and morbidity. Neuraxial anaesthesia should be considered as a routine adjunct to general anaesthesia for elective open abdominal aortic aneurysm repair.

Sections du résumé

BACKGROUND
Use of neuraxial anaesthesia for open abdominal aortic aneurysm repair is postulated to reduce mortality and morbidity. This study aimed to determine the 90-day outcomes after elective open abdominal aortic aneurysm repair in patients receiving combined general and neuraxial anaesthesia vs general anaesthesia alone.
METHODS
A retrospective population-based cohort study was conducted from 2003 to 2016. All patients ≥40 yr old undergoing open abdominal aortic aneurysm repair were included. The propensity score was used to construct inverse probability of treatment weighted regression models to assess differences in 90-day outcomes.
RESULTS
A total of 10 447 elective open abdominal aortic aneurysm repairs were identified; 9003 (86%) patients received combined general and neuraxial anaesthesia and 1444 (14%) received general anaesthesia alone. Combined anaesthesia was associated with significantly lower hazards for all-cause mortality (hazard ratio [HR]=0.47; 95% confidence interval [CI], 0.37-0.61) and major adverse cardiovascular events (HR=0.72; 95% CI, 0.60-0.86). Combined patients were at lower odds for acute kidney injury (odds ratio [OR]=0.66; 95% CI, 0.49-0.89), respiratory failure (OR=0.41; 95% CI, 0.36-0.47), and limb complications (OR=0.30; 95% CI, 0.25-0.37), with higher odds of being discharged home (OR=1.32; 95% CI, 1.15-1.51). Combined anaesthesia was also associated with significant mechanical ventilation and ICU and hospital length of stay benefits.
CONCLUSIONS
Combined general and neuraxial anaesthesia in elective open abdominal aortic aneurysm repair is associated with reduced 90-day mortality and morbidity. Neuraxial anaesthesia should be considered as a routine adjunct to general anaesthesia for elective open abdominal aortic aneurysm repair.

Identifiants

DOI: 10.1016/j.bja.2020.01.018 PMID: 32216957
pubmed: 32216957
pii: S0007-0912(20)30079-9
doi: 10.1016/j.bja.2020.01.018
pii:
doi:

Substances chimiques

Anesthetics, Combined 0

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

544-552

Subventions

Organisme : CIHR
Pays : Canada
Organisme : Canada; Department of Surgery,
Pays : International

Commentaires et corrections

Type : CommentIn

Informations de copyright

Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

Auteurs

Konrad Salata (K)

Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.

Faraj W Abdallah (FW)

Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Department of Anaesthesia, University of Ottawa, Ottawa, ON, Canada; Department of Anaesthesia, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada.

Mohamad A Hussain (MA)

Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.

Charles de Mestral (C)

Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.

Elisa Greco (E)

Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.

Badr Aljabri (B)

Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Department of Surgery, King Saud University, Riyadh, Saudi Arabia.

Muhammad Mamdani (M)

Li Ka Shing Centre for Healthcare Analytics Research and Training (CHART), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana Faculty of Public Health, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences at Sunnybrook Hospital, Toronto, ON, Canada.

C David Mazer (CD)

Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Department of Anaesthesia, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.

Thomas L Forbes (TL)

Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network and Toronto, University of Toronto, ON, Canada.

Subodh Verma (S)

Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Cardiac Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.

Mohammed Al-Omran (M)

Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Vascular Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Surgery, King Saud University, Riyadh, Saudi Arabia. Electronic address: alomranm@smh.ca.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Short-term outcomes of combined neuraxial and...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Short-term outcomes of combined neuraxial and...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › Short-term outcomes of combined neuraxial and...
questionsmedicales.fr › Anesthésie et analgésie › Anesthésie › Anesthésie de conduction › Anesthésie péridurale › Short-term outcomes of combined neuraxial and...
questionsmedicales.fr › Anesthésie et analgésie › Anesthésie › Anesthésie générale › Short-term outcomes of combined neuraxial and...
questionsmedicales.fr › Anesthésie et analgésie › Anesthésie › Anesthésie de conduction › Rachianesthésie › Short-term outcomes of combined neuraxial and...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents du système nerveux central › Dépresseurs du système nerveux central › Anesthésiques › Anesthésiques combinés › Short-term outcomes of combined neuraxial and...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Maladies de l'aorte › Anévrysme de l'aorte › Anévrysme de l'aorte abdominale › Short-term outcomes of combined neuraxial and...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Short-term outcomes of combined neuraxial and...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Hospitalisation › Durée du séjour › Short-term outcomes of combined neuraxial and...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Short-term outcomes of combined neuraxial and...
questionsmedicales.fr › Régions géographiques › Amériques › Amérique du Nord › Canada › Ontario › Short-term outcomes of combined neuraxial and...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Short-term outcomes of combined neuraxial and...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Short-term outcomes of combined neuraxial and...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Short-term outcomes of combined neuraxial and...