Carotid Endarterectomy Under Local Anesthesia Has Less Risk of Myocardial Infarction Compared to General Anesthesia: An Analysis of National Surgical Quality Improvement Program Database
As carotid endarterectomy (CEA) is being increasingly compared to carotid artery stenting and the best current medical management, it has become important to revisit variables that might affect the outcomes of the procedure. Multiple studies have evaluated the effect of anesthesia type on CEA with inconsistent results. Our study compared 30 day postoperative myocardial infarction (MI), stroke and mortality between CEA under local or regional anesthesia (LA) and CEA under general anesthesia (GA) utilizing National Surgical Quality Improvement Program (NSQIP) database.
All patients listed in NSQIP database that underwent CEA under GA and LA from 2005-2011 were included with the exception of patients undergoing simultaneous CEA and CABG. Postoperative MI, stroke, and death at 30 days were compared between the two groups using simple and multiple logistic regression.
A total of 42,265 CEA cases were included. 37,502 (88.7%) were performed under GA and 4763 (11.3%) under LA. CEA under LA had a significantly decreased risk of 30 day postoperative MI when compared to CEA under GA (0.4% vs 0.86%; P = .012). No statistically significant differences were found in postoperative stroke or mortality ( Table).
CEA under LA carries a decreased risk of postoperative MI when compared to CEA under GA. Patients with multiple comorbidities at risk of postoperative MI should be considered for CEA under LA. Table
Comparison of 30-day postoperative MI, stroke, and death for CEA under LA vs GA with and without adjustment for confounding factors CEA under LA (n = 4763)CEA under GA (n = 37,502)Unadjusted P valueAdjusted P value MI, No. (%) 20 (0.40) 323 (0.86) .002 .012 Stroke, No. (%) 66 (1.39) 592 (1.58) .318 .540 Death, No. (%) 32 (0.67) 315 (0.84) .227 .664
Kfoury, E., Dort, J., Trickey, A., Crosby, M., Mukherjee, D. Carotid endarterectomy under local anesthesia has less risk of myocardial infarction compared to general anesthesia: an analysis of national surgical quality improvement program database. Journal of Vascular Surgery, 57(5), Supplement , 47S, May 2013.