Use of Spinal Anesthesia During Thoracic Endovascular Aortic Repair.
Academic Article
Overview
abstract
BACKGROUND: The purpose of this study was to assess outcomes after spinal versus general anesthesia in patients undergoing thoracic endograft placement and to evaluate the adjunctive use of cerebrospinal fluid drain (CSFD) placement. METHODS: A single-center, retrospective review of patients that underwent thoracic endograft placement from 2001-2019 was performed. Patients were stratified based on the type of anesthesia they received: general anesthesia (GA), spinal/epidural (SA), GA with cerebrospinal fluid drain (CSFD), and SA with CSFD. Primary outcomes included 30-day mortality and length-of-stay (LOS). Baseline characteristics were analyzed with Student's T-test and Pearson Chi-squared. Multivariate logistic regression analysis was performed to identify risk factors for 30-day mortality and longer LOS. RESULTS: A total of 333 patients underwent thoracic endograft placement; 104 patients received SA, 180 patients received GA, 30 patients received GA and CSFD, and 19 patients received SA and CSFD. Of the total patients, 16.2% underwent thoracic endograft placement for type B aortic dissection, 3.3% for type A aortic dissection, and 12.3% for penetrating ulcer. The mean age of the study population was 68.7 years old. Patients undergoing spinal anesthesia were older with a mean age of 73.4 years versus 64.7 years for patients undergoing general anesthesia (P < 0.001). Spinal anesthesia was preferred in patients at high risk for general anesthesia (>75 years old: 52.9% vs. 33.3%, P < 0.001; renal comorbidities: 20.6% vs. 10.6%, P=0.03, and current smokers: 26.7% vs. 9.6%, P < 0.001). LOS was decreased in the spinal anesthesia group (4.29 days vs. 9.70 days, P < 0.001). There was a lower incidence of spinal cord ischemia in the SA group (1.0% vs. 2.2%, P = 0.44), as well as significantly decreased 30-day mortality (0% vs. 5.6%, P = 0.01), reintervention (19.2% vs. 26.8%, P = 0.02), and return to OR (6.8% vs. 12.7%, P = 0.02). Of the 19 patients that had SA + CSFD, there were no signs and symptoms of spinal cord ischemia and decreased incidence of perioperative complications (0% vs 33.3%, P=0.01). There was no difference in the risk for intraoperative complications, neurologic complications, or 30-day mortality between GA + CSFD patients vs SA + CSFD patients. Age >75 (P = 0.002), intraoperative complications (P<.001), and perioperative complications (P = 0.02) were associated with increased mortality after thoracic endograft placement per multivariate logistic regression analysis. CONCLUSIONS: SA in select high-risk patients was associated with reduced 30-day mortality, neurologic complications, and LOS compared to GA. The concurrent use of spinal drainage and SA had satisfactory results compared to spinal drainage and GA.
