General Anesthesia Does Not Increase Mortality and Morbidity in High-risk Patients Undergoing Carotid Endarterectomy

Myocardial infarction and stroke are known complications of general anesthesia, resulting in the effort to perform carotid endarterectomy (CEA) for high-risk patients under local/regional anesthesia. However, there few data supporting this practice. The ACS-NSQIP CEA targeted database was used identify all who underwent non-emergent from 2012 2021. Only were selected. High-risk defined as those with physiologic factors, congestive heart failure, chronic obstructive pulmonary disease, dyspnea, dialysis dependence. Patients further divided into anesthesia Propensity matching multiple logistic regression done determine effects type on 30-day mortality, cardiac events, stroke, other major organ dysfunction. A total 5218 identified; 4629 received 576 locoregional Overall, 564 remained each cohort after propensity matching. There no significant difference complications, renal between (Table). Among had outcomes markedly worse when operative time greater than 180 minutes (Figure). Although is theoretically a better choice patients, appears have comparable without higher risk cardiac, or complication. General could be safely population if can kept minutes.TableNo mortality morbidity undergoing endarterectomyAdjusted odds ratio, (n = 4629) vs 576)95% confidence intervalP valueMortality0.850.243.03.804MACEa0.710.331.49.361Stroke1.730.853.51.131Pulmonary complicationsb1.370.692.69.363Renal complicationsc1.620.269.14.583aMajor adverse events including myocardial infarction, arrest.bPostoperative pneumonia, reintubation, >48 hours ventilator.cAcute kidney injury, postoperative dialysis. Open table new tab