IP099. Regional Anesthesia for Carotid Endarterectomy Protects Against Cranial Nerve Injury

Optimal anesthesia for carotid endarterectomy remains controversial. We evaluated and compared short-term outcomes after carotid endarterectomy with general anesthesia (GA) or regional anesthesia (RA). The 2011 to 2015 American College of Surgeons National Surgical Quality Improvement Program Participant Use Data Files with merged Vascular Procedure Targeted Participant Use Data Files for carotid endarterectomy were queried for patients undergoing carotid endarterectomy. Operative time, postoperative complications, hospital and 30-day mortality, 30-day readmission, and hospital length of stay in cases with GA or RA were compared as appropriate with χ2 test, Wilcoxon rank sum test, and multivariable logistic regression. A total of 14,447 patients were evaluated, 12,389 (85.7%) with GA and 2058 (14.3%) with RA. The use of GA was inversely associated with patients’ age (88.0% in patients 22-64 years vs 83.4% in patients ≥80 years; P < .0001 for trend). Women were more likely to have GA compared with men (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.12-1.36), as were symptomatic patients compared with asymptomatic (OR, 1.25; 95% CI, 1.13-1.38). There were no differences between GA and RA for in-hospital mortality, 30-day mortality, or postoperative complications (myocardial infarction, transient ischemic attack, stroke, bleeding, acute renal failure, restenosis). However, rates of cranial nerve injury were significantly higher in GA compared with RA (2.9% vs 1.7%; P < .002) and confirmed by multivariable analysis (OR, 1.68; 95% CI, 1.19-2.39). Total operative time was also greater for GA (median, 115 minutes [interquartile range (IQR), 89-145] vs median, 93 minutes [IQR, 76-119]; P < .0001). Hospital length of stay was greater in GA (median, 1 day [IQR, 1-2 days] vs median, 1 day [IQR 1-1 day]; P < .0001), as were 30-day readmission rates (6.7% vs 5.4% [P = .02]; OR, 1.26; 95% CI, 1.03-1.55). RA during carotid endarterectomy reduces the rate of cranial nerve injury. RA was noninferior to general anesthesia at 30-day outcomes and associated with shorter operative times, length of hospital stay, and decreased 30-day readmission rates.