Carotid endarterectomy under local and/or regional anesthesia has less risk of myocardial infarction compared to general anesthesia: An analysis of national surgical quality improvement program database

Vascular ◽  
2014 ◽  
Vol 23 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Elias Kfoury ◽  
Jonathan Dort ◽  
Amber Trickey ◽  
Moira Crosby ◽  
Jean Donovan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Quality Improvement ◽  
General Anesthesia ◽  
Carotid Endarterectomy ◽  
Regional Anesthesia ◽  
Artery Bypass ◽  
Quality Improvement Program ◽  
Improvement Program ◽  
Surgical Quality ◽  
Postoperative Myocardial Infarction

Multiple studies have evaluated the effect of anesthesia type on carotid endarterectomy with inconsistent results. Our study compared 30-day postoperative myocardial infarction, stroke, and mortality between carotid endarterectomy under local or regional anesthesia and carotid endarterectomy under general anesthesia utilizing National Surgical Quality Improvement Program database. All patients listed in National Surgical Quality Improvement Program database that underwent carotid endarterectomy under general anesthesia and local or regional anesthesia from 2005 to 2011 were included with the exception of patients undergoing simultaneous carotid endarterectomy and coronary artery bypass grafting. The data revealed substantial differences between the two groups compared, and these were adjusted using multiple logistic regression. Postoperative myocardial infarction, stroke, and death at 30 days were compared between the two groups. A total of 42,265 carotid endarterectomy cases were included. A total of 37,502 (88.7%) were performed under general anesthesia and 4763 (11.3%) under local or regional anesthesia. Carotid endarterectomy under local or regional anesthesia had a significantly decreased risk of 30-day postoperative myocardial infarction when compared to carotid endarterectomy under general anesthesia (0.4% vs 0.86%, p = 0.012). No statistically significant differences were found in postoperative stroke or mortality. Carotid endarterectomy under local or regional anesthesia carries a decreased risk of postoperative myocardial infarction when compared to carotid endarterectomy under general anesthesia. Therefore, patients at risk of postoperative myocardial infarction undergoing carotid endarterectomy, consideration of local or regional anesthesia may reduce that risk.

Abstract TMP19: Carotid Endarterectomy in Patients With Thrombocytopenia. Analysis of National Surgical Quality Improvement Program (NSQIP) Registry

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Aiman Zafar ◽  
Vishal B Jani ◽  
Muhammad Shah Miran ◽  
Muhammad H Yousaf ◽  
Urvish Patel ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Carotid Endarterectomy ◽  
Large Population ◽  
Population Based ◽  
Quality Improvement Program ◽  
Blood Transfusions ◽  
Improvement Program ◽  
Surgical Quality ◽  
Carotid Revascularization ◽  
Procedural Complications

Background: Carotid revascularization procedures are infrequently performed in patients with mild-moderate thrombocytopenia. However, whether such procedures are associated with a higher unknown risk of peri-procedural complications such as myocardial infarction (MI)/arrhythmia, need for blood transfusions, unplanned intubations, and death. There is no large population based study available to quantify the risk after carotid endarterectomy (CEA) in patients with thrombocytopenia. Methods: We studied all patients who underwent CEA in the American College of Surgeons (ACS) National Surgical Quality Improvement Program(NSQIP) Registry between years 2011 and 2013.The ACS-NSQIP prospectively collects data on over 300 variables pertaining to patient characteristics, comorbid conditions, operative details, and 30-day post-operative outcomes. Thrombocytopenia was defined based on the pre procedure platelet count of <150,000 platelet/μL. The odds ratios for selected outcomes were calculated after adjusting for age, gender, and symptomatic status using logistic regression. Results: Thrombocytopenia was present in 931(10.5%) of 8835 patients who underwent CEA. Their severity of thrombocytopenia was mild (100,000-149,000 platelets/μL) and moderate (<100,000platelets/μL) in 821(88.18%) and 110(11.8%) patients, respectively. Patients with thrombocytopenia were more likely to be asymptomatic prior to CEA (54.4% vs. 45.6%; p=0.02). There was a significantly higher prevalence of MI/arrhythmia among patients with thrombocytopenia in compare to without (3.7% vs. 1.8%; odds ratio [OR]: 1.95; 95% confidence interval [CI]: 1.33-2.88; p<0.001). The incidence of unplanned intubation post CEA was higher among patients with thrombocytopenia (2.5% vs. 1.2%; p=0.004). There were no differences in the need for blood transfusions (2.5% vs. 2.4%; OR: 1.05; 95% CI: 0.67-1.64; p =0.83) and one month mortality (0.6% vs. 0.8%; OR: 0.66; 95% CI: 0.28-1.54; p=0.33) among patients with and without thrombocytopenia. Conclusions: The higher rate of post procedural complications in patients with thrombocytopenia needs to be recognized for appropriate risk stratification.

scholarly journals Outcomes after carotid endarterectomy: Is there a high-risk population? A National Surgical Quality Improvement Program report

2009 ◽  
Vol 49 (2) ◽  
pp. 331-339.e1 ◽  
Author(s):  
Jeanwan L. Kang ◽  
Thomas K. Chung ◽  
Robert T. Lancaster ◽  
Glenn M. LaMuraglia ◽  
Mark F. Conrad ◽  
...  
Keyword(s):  
Quality Improvement ◽  
High Risk ◽  
Carotid Endarterectomy ◽  
Quality Improvement Program ◽  
High Risk Population ◽  
Improvement Program ◽  
Surgical Quality ◽  
Risk Population
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