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Impact of anesthesia technique on the incidence of major complications after open aortic abdominal surgery: a cohort study


Licker, Marc; Christoph, Ellenberger; Cartier, Vanessa; Mugnai, Damiano; Murith, Nicolas; Kalangos, Afksendios; Aldenkortt, Marc; Cassina, Tiziano; Diaper, John (2013). Impact of anesthesia technique on the incidence of major complications after open aortic abdominal surgery: a cohort study. Journal of clinical anesthesia, 25(4):296-308.

Abstract

STUDY OBJECTIVE: To determine the risk factors of perioperative complications and the impact of intrathecal morphine (ITM) in major vascular surgery.
DESIGN: Retrospective analysis of a prospective cohort.
SETTINGS: Operating room, intensive care unit, and Postanesthesia Care Unit of a university hospital.
MEASUREMENTS: Data from 595 consecutive patients who underwent open abdominal aortic surgery between January 1997 and December 2011 were reviewed. Data were stratified into three groups based on the analgesia technique delivered: systemic analgesia (Goup SA), thoracic epidural analgesia (Group TEA), and intrathecal morphine (Group ITM). Preoperative patient characteristics, perioperative anesthetic and medical interventions, and major nonsurgical complications were recorded.
MAIN RESULTS: Patients managed with ITM (n=248) and those given thoracic epidural analgesia (n=70) required lower doses of intravenous (IV) sufentanil intraoperatively and were extubated sooner than those who received systemic analgesia (n=270). Total inhospital mortality was 2.9%, and 24.4% of patients experienced at least one major complication during their hospital stay. Intrathecal morphine was associated with a lower risk of postoperative morbidity (OR 0.51, 95% CI 0.28 - 0.89), particularly pulmonary complications (OR 0.54, 95% CI 0.31 - 0.93) and renal dysfunction (OR 0.52, 95% CI 0.29 - 0.97). Other predictors of nonsurgical complications were ASA physical status 3 and 4 (OR 1.94, 95% CI 1.07 - 3.52), preoperative renal dysfunction (OR 1.61, 95% CI 1.01 - 2.58), prolonged surgical time (OR 1.78, 95% CI 1.16 - 2.78), and the need for blood transfusion (OR 1.77, 95% CI 1.05 - 2.99).
CONCLUSIONS: This single-center study showed a decreased risk of major nonsurgical complications in patients who received neuraxial analgesia after abdominal aortic surgery.

Abstract

STUDY OBJECTIVE: To determine the risk factors of perioperative complications and the impact of intrathecal morphine (ITM) in major vascular surgery.
DESIGN: Retrospective analysis of a prospective cohort.
SETTINGS: Operating room, intensive care unit, and Postanesthesia Care Unit of a university hospital.
MEASUREMENTS: Data from 595 consecutive patients who underwent open abdominal aortic surgery between January 1997 and December 2011 were reviewed. Data were stratified into three groups based on the analgesia technique delivered: systemic analgesia (Goup SA), thoracic epidural analgesia (Group TEA), and intrathecal morphine (Group ITM). Preoperative patient characteristics, perioperative anesthetic and medical interventions, and major nonsurgical complications were recorded.
MAIN RESULTS: Patients managed with ITM (n=248) and those given thoracic epidural analgesia (n=70) required lower doses of intravenous (IV) sufentanil intraoperatively and were extubated sooner than those who received systemic analgesia (n=270). Total inhospital mortality was 2.9%, and 24.4% of patients experienced at least one major complication during their hospital stay. Intrathecal morphine was associated with a lower risk of postoperative morbidity (OR 0.51, 95% CI 0.28 - 0.89), particularly pulmonary complications (OR 0.54, 95% CI 0.31 - 0.93) and renal dysfunction (OR 0.52, 95% CI 0.29 - 0.97). Other predictors of nonsurgical complications were ASA physical status 3 and 4 (OR 1.94, 95% CI 1.07 - 3.52), preoperative renal dysfunction (OR 1.61, 95% CI 1.01 - 2.58), prolonged surgical time (OR 1.78, 95% CI 1.16 - 2.78), and the need for blood transfusion (OR 1.77, 95% CI 1.05 - 2.99).
CONCLUSIONS: This single-center study showed a decreased risk of major nonsurgical complications in patients who received neuraxial analgesia after abdominal aortic surgery.

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Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > Cardiocentro Ticino
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2013
Deposited On:04 Feb 2014 10:06
Last Modified:05 Apr 2016 17:29
Publisher:Elsevier
ISSN:0952-8180
Publisher DOI:https://doi.org/10.1016/j.jclinane.2013.01.009
PubMed ID:23685100

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