scholarly journals Outcomes of carotid endarterectomy under general and regional anesthesia from the American College of Surgeons' National Surgical Quality Improvement Program

2012 ◽  
Vol 56 (1) ◽  
pp. 81-88.e3 ◽  
Author(s):  
Stefan W. Leichtle ◽  
Nicolas J. Mouawad ◽  
Kathleen Welch ◽  
Richard Lampman ◽  
Walter M. Whitehouse ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Carotid Endarterectomy ◽  
Regional Anesthesia ◽  
Quality Improvement Program ◽  
Improvement Program ◽  
Surgical Quality ◽  
American College Of Surgeons

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.

Carotid Endarterectomy in Patients With Thrombocytopenia: Analysis of the National Surgical Quality Improvement Program Registry

2016 ◽  
Vol 13 (1) ◽  
pp. 150-156 ◽  
Author(s):  
Adnan I. Qureshi ◽  
Aiman Zafar ◽  
Muhammad Shah Miran ◽  
Vishal B. Jani
Keyword(s):  
Quality Improvement ◽  
Carotid Endarterectomy ◽  
Patient Characteristics ◽  
Quality Improvement Program ◽  
Comorbid Conditions ◽  
Forward Selection ◽  
Improvement Program ◽  
Surgical Quality ◽  
American College Of Surgeons ◽  
Ventilator Requirement

AbstractBACKGROUND: Carotid endarterectomy (CEA) is infrequently performed in patients with mild to moderate thrombocytopenia.OBJECTIVE: To determine whether preoperative thrombocytopenia is associated with a higher rate of complications after CEA.METHODS: We analyzed patient characteristics, comorbid conditions, operative details, and 30-day postoperative outcomes for patients who underwent CEA in the CEA-targeted American College of Surgeons National Surgical Quality Improvement Program Registry. Thrombocytopenia was defined based on the preprocedure platelet count of ≤150  000 platelets/μL. The odds ratios (ORs) for selected outcomes were calculated using logistic regression with stepwise forward selection with age, sex, symptomatic status, and high-risk individuals as potential confounders.RESULTS: Thrombocytopenia was present in 896 of 8658 patients (10.3%) who underwent CEA: mild (100 000-149 000 platelets/μL) and moderate (50 000-99 000 platelets/μL) in 805 patients (89.8%) and 91 patients (10.2%), respectively. The adjusted rates of myocardial infarction/arrhythmia (3.7% vs 1.8%; OR: 1.9; 95% confidence interval [CI]: 1.3-2.8; P = .001), unplanned intubations (2.6% vs 1.2%; OR: 2.2; 95% CI: 1.4-3.5; P = .001), ventilator requirement >48 hours (1.5% vs 0.7%; OR: 2.1; 95% CI: 1.1-3.8; P = .02), deep venous thrombosis/thrombophlebitis (0.7% vs 0.2%; OR: 3.7; 95% CI: 1.4-9.7; P = .01), and surgical deep incisional infections (0.3% vs 0.1%; OR: 4.3; 95% CI: 1.1-17.4; P = .04) post-CEA were higher among patients with thrombocytopenia compared with those without thrombocytopenia. Thrombocytopenia did not significantly contribute to 1-month mortality or stroke.CONCLUSION: The higher rate of postprocedure complications in patients with preoperative thrombocytopenia needs to be recognized for adequate risk stratification before CEA.

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