Yale School of Medicine, New Haven, CT.
Yale School of Medicine, New Haven, CT.
Ann Vasc Surg. 2021 May;73:336-343. doi: 10.1016/j.avsg.2020.11.035. Epub 2020 Dec 26.
The choice of anesthetic for carotid endarterectomy (CEA) continues to be controversial. Recent literature suggests improved outcomes with the use of regional anesthesia (RA) compared with general anesthesia (GA). The objective of this study was to examine the utilization and outcomes of RA for CEA using a national database.
The targeted CEA files of the American College of Surgeons' National Surgical Quality Improvement Program (2011-2017) were reviewed. Patients were stratified based on anesthesia type into RA and GA, and patients' characteristics were compared between the 2 groups. The outcomes of CEA under GA and RA were compared after 2:1 propensity matching.
There were 26,206 CEAs, and 14% (n = 3,664) were performed under RA, with no change in relative utilization during the study period (P = 0.557). Patients treated under RA were more likely to be older than 65 years (80.6% vs. 75.8%; P < 0.001) and White (90.8% vs. 83.5%; P < 0.001) but less likely to have diabetes (28.2% vs. 31.2%; P = 0.001), chronic obstructive pulmonary disease (10.2% vs. 10.5%; P < 0.001), and heart failure (1.0% vs. 1.5%; P = 0.02) and be symptomatic (37.4% vs. 42.7%; P < 0.001). After matching, there was no significant difference in baseline characteristics between the 2 groups. Patients undergoing RA were less likely to experience the combined end point of stroke, myocardial infarction, or mortality compared with GA. GA patients were more likely to have longer operating time and hospital length of stay.
CEA performed under RA is associated with improved outcomes compared with GA. RA is underutilized in carotid surgery, and strategies to optimize its use are needed.
颈动脉内膜切除术（CEA）的麻醉选择仍存在争议。近期文献表明，与全身麻醉（GA）相比，区域麻醉（RA）的使用可改善结果。本研究的目的是使用国家数据库检查 RA 用于 CEA 的使用情况和结果。
回顾美国外科医师学院国家手术质量改进计划（2011-2017 年）的目标 CEA 文件。根据麻醉类型将患者分为 RA 和 GA 组，并比较两组患者的特征。在 2:1 倾向匹配后比较 GA 和 RA 下 CEA 的结果。
共进行了 26206 例 CEA，其中 14%（n=3664）采用 RA，研究期间相对使用率无变化（P=0.557）。RA 治疗的患者年龄大于 65 岁的可能性更高（80.6% vs. 75.8%；P<0.001），白人的可能性更高（90.8% vs. 83.5%；P<0.001），但患有糖尿病的可能性较低（28.2% vs. 31.2%；P=0.001），慢性阻塞性肺疾病（10.2% vs. 10.5%；P<0.001）和心力衰竭（1.0% vs. 1.5%；P=0.02）的可能性较低，且症状性的可能性较低（37.4% vs. 42.7%；P<0.001）。匹配后，两组患者的基线特征无显著差异。与 GA 相比，接受 RA 的患者发生中风、心肌梗死或死亡的复合终点的可能性较低。GA 患者的手术时间和住院时间更长。
与 GA 相比，RA 下进行的 CEA 结果更好。RA 在颈动脉手术中的应用不足，需要优化其使用策略。
