Does Gender or Use of Regional Anesthesia Have Influence on Carotid Endarterectomy Outcomes?

Abstract

Carotid endarterectomy (CEA) is the most commonly performed surgical procedure to reduce risk of stroke. The operation may be performed under regional (RA) or general anesthesia (GA). Despite perceived advantages of RA, previous trials have found no difference in incidence of transient ischemic attack, stroke, myocardial infarction (MI), and death with RA compared with GA. A retrospective review was performed to determine if postoperative outcomes were influenced by gender or the type of anesthesia used, or both. Patients who underwent CEA between 2005 and 2011 were extracted from the American College of Surgeons National Surgical Quality Improvement Program database. The cohort was separated by sex and anesthesia type. Primary end points included 30-day incidence of stroke and MI. Secondary end points included 30-day postoperative local complications, operative time, and surgical length of stay. Most of the 41,442 CEA patients were men (24,568 male, 16,874 female), and most cases were performed under GA (85% male, 86% female). Adjusted multivariate analysis showed no statistical difference between primary end point outcomes based on gender or type of anesthesia used. There was, however, a trend for increased risk of 30-day postoperative local complications and 30-day incidence of MI in operations conducted under GA compared with RA. Operative time and length of stay was decreased in women, regardless of anesthesia used (mean difference, −8.15 [10.09, −6.21] P < .0001; 0.34 [0.14, 0.54] P < .02). GA was associated with increased operative time and increased total surgical length of stay, regardless of sex, with statistical significance. There is no significant difference in postoperative outcomes between women and men regardless of type of anesthesia used for CEA. GA was associated with increased length of stay and operative time compared with RA in women and men, suggesting that choice of anesthesia may have significant economic effect for patients and institutions. The trend of increased 30-day postoperative local complications and 30-day MI among GA cases also supports the use of RA for CEA. These factors warrant further evaluation to improve patient outcomes and the economic effect of this commonly performed procedure.