In Patients with Heart Failure Undergoing Carotid Endarterectomy, Locoregional Anesthesia is Not Associated with Decreased Mortality, Stroke, or Myocardial Infarction Compared to General Anesthesia

Abstract

ObjectiveWhile existing literature reports no benefit of locoregional anesthesia (LRA) over general anesthesia (GA) in patients undergoing carotid endarterectomy (CEA), the effect of LRA on patients with congestive heart failure (CHF) has not been explored. This study aims to assess whether the choice of anesthesia plays a role in influencing outcomes within this population. MethodsUsing the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) files between 2005-2022 and the procedural targeted ACS-NSQIP database for CEA between 2011-2022, all patients receiving CEA were identified, and the subset of patients with CHF was included. Patient characteristics and 30-day outcomes were compared using χ2 or Fischer’s exact test as appropriate for categorical variables and the independent t-test or Mann-Whitney U test as appropriate for continuous variables. Mortality, stroke, myocardial infarction (MI), and major adverse cardiac events (MACE) were compared between patients receiving general anesthesia (GA) and locoregional anesthesia (LRA) using univariate analysis. ResultsA total of 3,040 patients (2,733 undergoing GA, 307 undergoing LRA) with a diagnosis of CHF undergoing CEA were identified. No difference in mortality (GA 3.1% vs LRA 4.6%, p=0.162), MI (GA 3.0% vs LRA 2.3%, p=0.478), stroke (2.4% vs 2.6%, p=0.805) or MACE (GA 7.4% vs LRA 8.1%, p=0.654) was observed. LRA patients had a significantly lower hospital stay compared to GA patients (1 day [IQR 1-3] vs 2 days [IQR 1-4], p<0.001). Shunt was more commonly used in patients receiving GA (32.9% vs 12.5%, p<0.001) compared to LRA. ConclusionWhile utilizing LRA compared to GA during carotid endarterectomy in patients with CHF is associated with a shorter hospital stay and less intraoperative shunting, the choice of anesthesia did not impact the outcomes of mortality, MI or stroke. Further research is needed to determine the effect of LRA on the outcomes of CEA among patients with different stages of heart failure.