Bristol Centre for Surgical Research, University of Bristol, Bristol, UK; Department of Vascular Surgery, Southmead Hospital, Bristol, UK.
Clinical Trials and Evaluation Unit, Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, UK.
Eur J Vasc Endovasc Surg. 2020 May;59(5):729-738. doi: 10.1016/j.ejvs.2020.01.031. Epub 2020 Apr 11.
Endovascular aneurysm repair (EVAR) is the most commonly used method to repair abdominal aortic aneurysms. EVAR can be performed using a variety of anaesthetic techniques, including general anaesthetic (GA), regional anaesthetic (RA), and local anaesthetic (LA), but little is known about the effects that each of these anaesthetic modes have on patient outcome. The aim of this study was to assess the effect of anaesthetic technique on early outcomes after elective EVAR.
Data from the UK's National Vascular Registry were analysed. All patients undergoing elective standard infrarenal EVAR between 1 January 2014 and 31 December 2016 were included. Patients with a symptomatic aneurysm treated semi-electively were excluded. The primary outcome was in hospital death within 30 days of surgery. Secondary outcomes included post-operative complications and length of hospital stay. Time to event outcomes were compared using Cox proportional hazards regression adjusted for confounders, including British Aneurysm Repair score (a validated aneurysm risk prediction score that is calculated using age, sex, creatinine, cardiac disease, electrocardiogram, previous aortic surgery, white blood cell count, serum sodium, abdominal aortic aneurysm diameter, and American Society of Anaesthesiologists grade) and chronic lung disease.
A total of 9783 patients received an elective, standard infrarenal EVAR (GA, n = 7069; RA, n = 2347; and LA, n = 367) across 89 hospitals. RA and/or LA was used in 82 hospitals. There were 64 in hospital deaths within 30 days, 50 (0.9% mortality at 30 days, 95% confidence interval [CI] 0.7-1.2) in the GA group, 11 (0.6%, 95% CI 0.3-1.1) in the RA group, and three (1.5%, 95% CI 0.5-4.7) in the LA group. The mortality rate differed between groups (p = .03) and was significantly lower in the RA group compared with the GA group (adjusted hazard ratio [aHR] RA/GA 0.37 [95% CI 0.17-0.81]; LA/GA 0.63 [95% CI 0.15-2.69]). The median length of stay was two days for all modes of anaesthesia, but patients were discharged from hospital more quickly in the RA and LA groups than the GA group (aHR RA/GA 1.10 [95% CI 1.03-1.17]; LA/GA 1.15 [95% CI 1.02-1.29]). Overall, 20.7% of patients experienced one or more complications (GA group, 22.1%; RA group, 16.8%; LA group, 17.7%) and pulmonary complications occurred with similar frequency in the three groups (overall 2.4%, adjusted odds ratio RA/GA 0.93 [95% CI 0.66-1.32]; LA/GA 0.82 [95% CI 0.41-1.63]).
Thirty day mortality was lower with RA than with GA, but mode of anaesthesia was not associated with increased complications for patients undergoing elective standard infrarenal EVAR.
血管内动脉瘤修复术（EVAR）是修复腹主动脉瘤最常用的方法。EVAR 可以使用多种麻醉技术进行，包括全身麻醉（GA）、区域麻醉（RA）和局部麻醉（LA），但对于每种麻醉模式对患者预后的影响知之甚少。本研究旨在评估麻醉技术对择期 EVAR 后早期结果的影响。
分析了英国国家血管登记处的数据。纳入了 2014 年 1 月 1 日至 2016 年 12 月 31 日期间接受择期标准肾下 EVAR 的所有患者。排除了半择期治疗症状性动脉瘤的患者。主要结局为术后 30 天内院内死亡。次要结局包括术后并发症和住院时间。使用 Cox 比例风险回归比较时间依赖结局，调整了混杂因素，包括英国动脉瘤修复评分（一种经过验证的动脉瘤风险预测评分，使用年龄、性别、肌酐、心脏病、心电图、既往主动脉手术、白细胞计数、血清钠、腹主动脉瘤直径和美国麻醉师协会分级计算）和慢性肺部疾病。
共有 9783 名患者在 89 家医院接受了择期标准肾下 EVAR（GA 组 n=7069；RA 组 n=2347；LA 组 n=367）。82 家医院使用了 RA 和/或 LA。术后 30 天内有 64 例院内死亡，GA 组 50 例（30 天死亡率为 0.9%，95%置信区间[CI]为 0.7-1.2），RA 组 11 例（0.6%，95%CI 为 0.3-1.1），LA 组 3 例（1.5%，95%CI 为 0.5-4.7）。各组之间死亡率不同（p=0.03），RA 组明显低于 GA 组（调整后的危险比[HR]RA/GA 0.37[95%CI 0.17-0.81]；LA/GA 0.63[95%CI 0.15-2.69]）。所有麻醉模式的中位住院时间均为两天，但 RA 和 LA 组患者出院时间快于 GA 组（HR RA/GA 1.10[95%CI 1.03-1.17]；LA/GA 1.15[95%CI 1.02-1.29]）。总体而言，20.7%的患者发生了一种或多种并发症（GA 组 22.1%；RA 组 16.8%；LA 组 17.7%），三组肺部并发症发生率相似（总体 2.4%，调整后的优势比 RA/GA 0.93[95%CI 0.66-1.32]；LA/GA 0.82[95%CI 0.41-1.63]）。
与 GA 相比，RA 术后 30 天死亡率较低，但对于接受择期标准肾下 EVAR 的患者，麻醉方式与并发症发生率增加无关。
