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

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.

journal_name

J Clin Anesth

journal_title

Journal of clinical anesthesia

authors

Licker M,Christoph E,Cartier V,Mugnai D,Murith N,Kalangos A,Aldenkortt M,Cassina T,Diaper J

doi

10.1016/j.jclinane.2013.01.009

subject

Has Abstract

pub_date

2013-06-01 00:00:00

pages

296-308

issue

eissn

0952-8180

issn

1873-4529

pii

S0952-8180(13)00137-2

journal_volume

pub_type

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