General Anesthesia Is Associated with Higher Limb Loss and Pulmonary Complications Than Higher Mortality/Cardiac Events Compared with Regional/Spinal/Epidural Anesthesia for Lower-Extremity Bypass

Abstract

INTRODUCTION: Despite its well-known associated cardiac morbidities, general anesthesia (GA) is most often used for lower extremity bypass (LEB) instead of other modalities such as regional/spinal/epidural anesthesia. Nevertheless, there is very little data about difference in outcomes between general vs other anesthetic modalities, especially in the high-risk patient population. METHODS: Patients who underwent non-emergent LEB were identified in the American College of Surgeons National Surgical Quality Improvement Lower Extremity Open Targeted database from 2011-2020. They were stratified into two groups: GA and other anesthesia (OA). Propensity matching was performed to mitigate the differences in demographics and preoperative comorbidities. Multivariable analysis was done to correct for differences in surgical indications, surgical procedures, and choices of conduits. Surgical outcomes were studied. Sub-analysis for high-risk patients (chronic obstructive pulmonary disease (COPD) and/or congestive heart failure (CHF)) was performed. RESULTS: After propensity matching, there were two comparable groups, 5,524 GA and 1,544 OA (Figure). Multivariable analysis showed no significant differences in 30-day mortality, major adverse cardiac events (MACE), pulmonary, and renal complications. GA was associated with higher major amputations (3.0% vs 1.5%; OR = 1.91, p < 0.01). In the high-risk population, GA was associated with higher pulmonary complications than OA (4.5% vs 1.7%; OR = 2.95, p = 0.03). CONCLUSION: General anesthesia does not appear to cause higher mortality or cardiac complications in leg bypass but is associated with higher limb loss in the general population and higher pulmonary complications in patients with COPD/CHF. Other modes of anesthesia should be considered for high-risk population.Figure