TY - JOUR
T1 - Short-term outcomes of combined neuraxial and general anaesthesia versus general anaesthesia alone for elective open abdominal aortic aneurysm repair
T2 - retrospective population-based cohort study†
AU - Salata, Konrad
AU - Abdallah, Faraj W.
AU - Hussain, Mohamad A.
AU - de Mestral, Charles
AU - Greco, Elisa
AU - Aljabri, Badr
AU - Mamdani, Muhammad
AU - Mazer, C. David
AU - Forbes, Thomas L.
AU - Verma, Subodh
AU - Al-Omran, Mohammed
N1 - Funding Information:
SV reports grants and personal fees from Amgen , personal fees from AstraZeneca , grants and personal fees from Boehringher-Ingelheim , grants from Bristol-Myers Squibb , personal fees from Eli Lilly , personal fees from Merck , personal fees from Novartis , personal fees from Novo Nordisk , personal fees from Sanofi , personal fees from Servier , and personal fees from Valeant , outside the submitted work. The remaining authors of this manuscript declare no conflicts of interests.
Funding Information:
Division of Vascular Surgery at St. Michael’s Hospital , Toronto, Ontario, Canada; Department of Surgery, King Saud University , Riyadh, Kingdom of Saudi Arabia. Canadian Institutes of Health Research Canada Graduate Scholarship Master's salary support award, Goerc and Toronto Academic Vascular Specialists Surgeon Scientist Training Program Scholarship, and Ontario Graduate Scholarship to KS.
Funding Information:
SV reports grants and personal fees from Amgen, personal fees from AstraZeneca, grants and personal fees from Boehringher-Ingelheim, grants from Bristol-Myers Squibb, personal fees from Eli Lilly, personal fees from Merck, personal fees from Novartis, personal fees from Novo Nordisk, personal fees from Sanofi, personal fees from Servier, and personal fees from Valeant, outside the submitted work. The remaining authors of this manuscript declare no conflicts of interests.Division of Vascular Surgery at St. Michael's Hospital, Toronto, Ontario, Canada; Department of Surgery, King Saud University, Riyadh, Kingdom of Saudi Arabia. Canadian Institutes of Health Research Canada Graduate Scholarship Master's salary support award, Goerc and Toronto Academic Vascular Specialists Surgeon Scientist Training Program Scholarship, and Ontario Graduate Scholarship to KS.Atul Sivaswamy, MSc, Institute for Clinical Evaluative Sciences (ICES) at Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada, helped with dataset creation and analysis. No direct compensation was provided. However, administrative and analyst fees were paid to ICES for provision of the above services. This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and/or information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions and statements expressed in the material are those of the author(s), and not necessarily those of CIHI.
Publisher Copyright:
© 2020 British Journal of Anaesthesia
PY - 2020/5
Y1 - 2020/5
N2 - Background: Use of neuraxial anaesthesia for open abdominal aortic aneurysm repair is postulated to reduce mortality and morbidity. This study aimed to determine the 90-day outcomes after elective open abdominal aortic aneurysm repair in patients receiving combined general and neuraxial anaesthesia vs general anaesthesia alone. Methods: A retrospective population-based cohort study was conducted from 2003 to 2016. All patients ≥40 yr old undergoing open abdominal aortic aneurysm repair were included. The propensity score was used to construct inverse probability of treatment weighted regression models to assess differences in 90-day outcomes. Results: A total of 10 447 elective open abdominal aortic aneurysm repairs were identified; 9003 (86%) patients received combined general and neuraxial anaesthesia and 1444 (14%) received general anaesthesia alone. Combined anaesthesia was associated with significantly lower hazards for all-cause mortality (hazard ratio [HR]=0.47; 95% confidence interval [CI], 0.37–0.61) and major adverse cardiovascular events (HR=0.72; 95% CI, 0.60–0.86). Combined patients were at lower odds for acute kidney injury (odds ratio [OR]=0.66; 95% CI, 0.49–0.89), respiratory failure (OR=0.41; 95% CI, 0.36–0.47), and limb complications (OR=0.30; 95% CI, 0.25–0.37), with higher odds of being discharged home (OR=1.32; 95% CI, 1.15–1.51). Combined anaesthesia was also associated with significant mechanical ventilation and ICU and hospital length of stay benefits. Conclusions: Combined general and neuraxial anaesthesia in elective open abdominal aortic aneurysm repair is associated with reduced 90-day mortality and morbidity. Neuraxial anaesthesia should be considered as a routine adjunct to general anaesthesia for elective open abdominal aortic aneurysm repair.
AB - Background: Use of neuraxial anaesthesia for open abdominal aortic aneurysm repair is postulated to reduce mortality and morbidity. This study aimed to determine the 90-day outcomes after elective open abdominal aortic aneurysm repair in patients receiving combined general and neuraxial anaesthesia vs general anaesthesia alone. Methods: A retrospective population-based cohort study was conducted from 2003 to 2016. All patients ≥40 yr old undergoing open abdominal aortic aneurysm repair were included. The propensity score was used to construct inverse probability of treatment weighted regression models to assess differences in 90-day outcomes. Results: A total of 10 447 elective open abdominal aortic aneurysm repairs were identified; 9003 (86%) patients received combined general and neuraxial anaesthesia and 1444 (14%) received general anaesthesia alone. Combined anaesthesia was associated with significantly lower hazards for all-cause mortality (hazard ratio [HR]=0.47; 95% confidence interval [CI], 0.37–0.61) and major adverse cardiovascular events (HR=0.72; 95% CI, 0.60–0.86). Combined patients were at lower odds for acute kidney injury (odds ratio [OR]=0.66; 95% CI, 0.49–0.89), respiratory failure (OR=0.41; 95% CI, 0.36–0.47), and limb complications (OR=0.30; 95% CI, 0.25–0.37), with higher odds of being discharged home (OR=1.32; 95% CI, 1.15–1.51). Combined anaesthesia was also associated with significant mechanical ventilation and ICU and hospital length of stay benefits. Conclusions: Combined general and neuraxial anaesthesia in elective open abdominal aortic aneurysm repair is associated with reduced 90-day mortality and morbidity. Neuraxial anaesthesia should be considered as a routine adjunct to general anaesthesia for elective open abdominal aortic aneurysm repair.
KW - abdominal aortic aneurysm
KW - neuraxial anaesthesia
KW - open aneurysm repair
KW - population-based research
KW - retrospective cohort
UR - http://www.scopus.com/inward/record.url?scp=85082140785&partnerID=8YFLogxK
U2 - 10.1016/j.bja.2020.01.018
DO - 10.1016/j.bja.2020.01.018
M3 - Article
C2 - 32216957
AN - SCOPUS:85082140785
VL - 124
SP - 544
EP - 552
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
SN - 0007-0912
IS - 5
ER -