P023: COMPARISON OF ANESTHESIA TYPES IN ELECTIVE ENDOVASCULAR REPAIR IN THE AMERICAN COLLEGE OF SURGEONS NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM DATABASE
Ahraz A Rizvi, BS1; Waseem Wahood, MS1; Kayla Yoshida, MD2; 1Dr. Kiran C. Patel College of Allopathic Medicine; 2Kendall Regional Hospital
Background: Endovascular repair of infrarenal abdominal aortic aneurysms (EVAR) using general, spinal, epidural, and local/monitored anesthesia treatment (MAC) was investigated using a national surgical database.
Methods: The National Surgical Quality Improvement Project Vascular-targeted database was queried from 2011 to 2019 for elective EVAR patients. Patient demographics were analyzed between types of anesthesia including: general, spinal, epidural and MAC/local anesthesia using chi-square and ANOVA. Multivariable logistic regression, adjusted for patient demographics and comorbidities, was conducted for 30-day readmission. Possion regression was conducted for length of stay (LOS), and operative time Ruptured AAAs were excluded from analysis.
Results: 15,300 patients who underwent EVAR were queried. 14,019 (x%) received general anesthesia, 361 (x%) with spinal anesthesia, 143 (0.93%) with epidural anesthesia, and 777 (x%) with local/MAC. Compared to general anesthesia, there were similar odds of readmission for spinal (OR: 0.73; p=0.22), epidural (OR: 1.46; p=0.21), and MAC/local (OR: 0.88; p=0.41). Spinal (p=0.004) and MAC/local anesthesia were associated with lower length of stay by 18% and 24% compared to general anesthesia, respectively (p=0.004 and p<0.001). Epidural anesthesia was associated with a higher length of stay by 31% (p<0.001). Spinal (p=0.004) and epidural anesthesia were associated with higher operative time by 2% and 12% compared to general anesthesia, respectively (p=0.004 and p<0.001). MAC/local anesthesia was associated with lower operative time by 12% (p<0.001).
Conclusion: Our data showed that, based on current United States anesthesia and surgical practices, there were similar odds of readmission for all types of anesthesia. When compared to general anesthesia, the following trends were observed: Spinal anesthesia was associated with a smaller length of stay with a longer operative time, MAC/local anesthesia was associated with a reduced length of stay and a lower operative time, epidural anesthesia was associated with a longer length of stay and a longer operative time. Our data suggest that utilization of less invasive anesthesia could be a viable alternative method of anesthesia for elective EVAR procedures.