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4086
Perioperative Outcomes After Peripheral Nerve Block or Neuraxial Versus General Anesthesia for Above Knee Amputations
Session: MP-05a
Fri, Nov. 17, 8:00-10:00 am
Hampton Room

Please note, medically challenging cases are removed three months after the meeting and scientific abstracts after three years.

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PERIOPERATIVE OUTCOMES AFTER REGIONAL VERSUS GENERAL ANESTHESIA FOR ABOVE KNEE AMPUTATIONS

Andrew J.B. Pisansky MD, MS1, Ethan Y. Brovman MD1, Christine Kuo BA2, Alan D. Kaye, MD, PhD3, Richard D. Urman MD, MBA1,2

BACKGROUND

§Non-traumatic lower extremity amputation remains a common procedure among patients who frequently have significant co-morbidities

§ Patients undergoing above knee amputation (AKA) have the highest rates of mortality in this cohort

§ There is little evidence to support selection between peripheral nerve block or neuraxial regional anesthesia (RA) versus general anesthetic (GA)

 

OBJECTIVE

§ To determine whether regional anesthesia (neuraxial or peripheral nerve block) techniques were associated with more favorable outcomes versus general anesthesia among patients undergoing AKA

 

METHODS & DATA ANALYSIS

 

§ Design: retrospective cohort study using propensity matched groups

§ Patients undergoing AKA were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) dataset and grouped according to anesthetic type (RA vs. GA)

§Primary outcome: 30 day mortality

§ Secondary outcomes: included cardiac, pulmonary, infectious, and bleeding complications, as well as length of stay

§Among a subset of patients for whom readmissions data was available, rate of readmission was compared as a secondary outcome

 

RESULTS

§ 9,999 patients were identified in the ACS-NSQIP database§ 1,312 received a regional anesthetic and the remainder had a general anesthetic§ Factors significantly associated with GA included younger age (70 vs. 75 years; p < 0.001), higher BMI (26.5 vs. 25.4; p < 0.001) and ethnically white (62.4% vs. 57%; p < 0.001)§Prior to matching, patients receiving RA were less likely to be smokers (22% vs. 29%; p < 0.001), have a bleeding disorder (15% vs 30%; p < 0.001), or have a diagnosis of sepsis (26% vs 34%; p < 0.001)§ Propensity score matching produced a cohort composed of 1,916 patients equally divided between RA and GA§We found no difference with respect to the primary endpoint of 30 day mortality (11.7% vs 11.7%; OR 1.01; p = 0.943) nor was there any difference with respect to the secondary outcomes§Among patients for whom readmissions data were available, there was no statistically significant difference between rates of readmission between the groups (15.6% for RA vs. 12.7% for GA; OR 1.26, CI 0.87 – 1.828, p = 0.221)
 
CONCLUSIONS
 
§The present investigation did not detect any difference between regional and general anesthetic with respect to morbidity or mortality among patients undergoing AKA§This dataset did not allow us to address other relevant markers including pain control or phantom limb syndrome
 
 

 

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