Is General Anesthesia for Peripheral Vascular Surgery Correlated with Impaired Outcome in Patients with Cardiac Comorbidity? A Closer Look into the Nationwide Danish Cohort

Abstract

ObjectiveGeneral anesthesia (GA) may impair outcome after vascular surgery. The use of anticoagulant medication is often used in patients with cardiac comorbidity. Regional anesthesia (RA) requires planning of discontinuation before neuraxial blockade(s) in this subgroup. The aim was to describe the effect of anesthesia choice on outcome after vascular surgery in patients with known cardiac comorbidity. DesignRetrospective cohort study. SettingDanish hospitals. Participants6302 patients with known cardiac comorbidity, defined as ischemic heart disease, valve disease, pulmonary vascular disease, heart failure, and cardiac arrhythmias, undergoing lower extremity vascular surgery between 2005 and 2017. InterventionsGA versus RA. Measurements and Main ResultsData were extracted from national registries. GA was defined as anesthesia with mechanical ventilation. Multivariable regression models were used to describe the incidence of postoperative complications as well as 30-day mortality, hypothesizing a better outcome after RA. The rate of RA decreased from 48% in 2005 to 20% in 2017. The number of patients with ≥1 complications was 9.7 vs 6.2% (p <.001) and 30-day mortality was 6.0 vs 3.4% (p <.001) after GA. After adjusting for baseline differences, odds ratio (OR) was significantly lower for medical complications (cardiac, pulmonary, renal, new dialysis, intensive care unit and other medical complications) (OR 0.97 (0.95-0.98)) and 30-day mortality (OR 0.98 (0.97-0.99)) after RA. ConclusionsRA may be associated with a better outcome than GA after lower extremity vascular surgery, in patients with cardiac comorbidity. Prioritizing RA, despite the inconvenience of discontinuing anticoagulants, may be recommended.