Impact of regional anesthesia on outcomes of geriatric patients undergoing lower extremity revascularization: A propensity score-matched cohort study

被引:6
作者
Lim, Jung A. [1 ]
Seo, Yohan [1 ]
Choi, Eun-Joo [1 ]
Kwak, Sang Gyu [2 ]
Ryu, Taeha [1 ]
Lee, Jae Hoon [3 ]
Park, Ki Hyuk [3 ]
Roh, Woon Seok [1 ,4 ]
机构
[1] Daegu Catholic Univ, Sch Med, Dept Anesthesiol & Pain Med, Daegu, South Korea
[2] Daegu Catholic Univ, Sch Med, Dept Med Stat, Daegu, South Korea
[3] Daegu Catholic Univ, Sch Med, Dept Surg, Div Vasc & Endovascular Surg, Daegu, South Korea
[4] Daegu Catholic Univ, Sch Med, Dept Anesthesiol & Pain Med, 33,Duryugongwon Ro 17 Gil, Daegu 42472, South Korea
关键词
peripheral arterial disease; regional anesthesia; mortality; survival rate; LONG-TERM SURVIVAL; GENERAL-ANESTHESIA; POPULATION; SURGERY; MANAGEMENT; PROGNOSIS;
D O I
10.1097/MD.0000000000032597
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Lower extremity revascularization (LER) for peripheral artery disease in elderly patients is associated with a high risk of perioperative morbidity and mortality. This study aimed to a conduct retrospective review and propensity score matching analysis to determine whether the use of regional anesthesia (RA) instead of general anesthesia (GA) in geriatric patients undergoing LER for peripheral artery disease results in improved short-term mortality and health outcomes. We reviewed medical records of 1271 patients aged >65 years who underwent LER at our center between May 1998 and February 2016. According to the anesthesia method, patients were grouped in the GA and RA groups. The primary outcome was short-term mortality (7-day and 30-day). The secondary outcomes were 5-year survival rate, intraoperative events, postoperative morbidity, and postoperative length of stay. A propensity score-matched cohort design was used to control for potentially confounding factors including patient demographics, comorbidities, American Society of Anesthesiologists physical status, and preoperative medications. After propensity score matching, 722 patients that received LER under GA (n = 269) or RA (n = 453) were identified. Patients from the GA group showed significantly higher 7-day mortality than those from the RA group (5.6% vs 2.7% P = .048); however, there was no significant difference in 30-day mortality between the groups (GA vs RA: 6.3% vs 3.6%, P = .083). The 5-year survival rate and incidence of arterial and central venous catheter placement or intraoperative dopamine and epinephrine use were significantly higher in the GA group than in the RA group (P < .05). In addition, the frequency of immediate postoperative oxygen therapy or mechanical ventilation support was higher in the GA group (P < .05). However, there was no difference in the postoperative cardiopulmonary and cerebral complications between the 2 groups. These results suggest that RA can reduce intraoperative hemodynamic support and provide immediate postoperative respiratory intensive care. In addition, the use of RA may be associated with better short-term and 5-year survival rates in geriatric patients undergoing LER.
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页数:6
相关论文
共 20 条
[1]  
Anton James M, 2014, Anesthesiol Clin, V32, P661, DOI 10.1016/j.anclin.2014.05.004
[2]   Peripheral Arterial Disease: Current Perspectives and New Trends in Management [J].
Aslam, Farhan ;
Haque, Attiya ;
Foody, Joanne ;
Lee, L. Veronica .
SOUTHERN MEDICAL JOURNAL, 2009, 102 (11) :1141-1149
[3]   Regional Versus General Anaesthesia in Peripheral Vascular Surgery: a Propensity Score Matched Nationwide Cohort Study of 17 359 Procedures in Denmark [J].
Bisgaard, Jannie ;
Torp-Pedersen, Christian ;
Rasmussen, Bodil S. ;
Houlind, Kim C. ;
Riddersholm, Signe J. .
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 2021, 61 (03) :430-438
[4]   Modern Lower Extremity Bypass Outcomes by Anesthesia Type in the Veteran Population [J].
Boyd, Sally ;
Dittman, James M. ;
Tse, Wayne ;
Lavingia, Kedar S. ;
Amendola, Michael F. .
ANNALS OF VASCULAR SURGERY, 2022, 80 :187-195
[5]   Similar mortality with general or regional anesthesia in elderly hip fracture patients [J].
Brox, W. Timothy ;
Chan, Priscilla H. ;
Cafri, Guy ;
Inacio, Maria C. S. .
ACTA ORTHOPAEDICA, 2016, 87 (02) :152-157
[6]  
Chen WH, 2015, CAN J ANESTH, V62, P369, DOI 10.1007/s12630-015-0316-0
[7]   A Comparison of Epidural Analgesia and Traditional Pain Management Effects on Survival and Cancer Recurrence after Colectomy A Population-based Study [J].
Cummings, Kenneth C., III ;
Xu, Fang ;
Cummings, Linda C. ;
Cooper, Gregory S. .
ANESTHESIOLOGY, 2012, 116 (04) :797-806
[8]  
Gerhard-Herman MD, 2017, J AM COLL CARDIOL, V69, pE71, DOI [10.1161/CIR.0000000000000471, 10.1016/j.jacc.2016.11.007]
[9]   Anesthesia-Based Evaluation of Outcomes of Lower-Extremity Vascular Bypass Procedures [J].
Ghanami, Racheed J. ;
Hurie, Justin ;
Andrews, Jeanette S. ;
Harrington, Robert N. ;
Corriere, Matthew A. ;
Goodney, Philip P. ;
Hansen, Kimberley J. ;
Edwards, Matthew S. .
ANNALS OF VASCULAR SURGERY, 2013, 27 (02) :199-207
[10]   A comparison of regional and general anesthesia effects on 5 year survival and cancer recurrence after transurethral resection of the bladder tumor: a retrospective analysis [J].
Jang, Dale ;
Lim, Chae Seong ;
Shin, Yong Sup ;
Ko, Young Kwon ;
Park, Sang Il ;
Song, Seong Hyun ;
Kim, Bum June .
BMC ANESTHESIOLOGY, 2016, 16