Neuraxial block, death and serious cardiovascular morbidity in the POISE trial

Leslie, Kate; Myles, Paul S.; Devereaux, P. J.; Williamson, Elizabeth; Rao‐Melacini, Purnima; Forbes, Andrew Benjamin; Xu, Shunqing; Foëx, P.; Pogue, Janice; Arrieta, Maribel; Bryson, Gregory L.; Paul, James; Paech, Michael J.; Merchant, Richard; Choi, P.; Badner, Neal H.; Peyton, Philip J; Sear, J.W.; Yang, Homer

doi:10.1093/bja/aet120

Cited by 75 publications

(48 citation statements)

References 29 publications

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“…Uncertainty remains in part because previous studies did not differentiate between neuraxial anesthesia alone vs the combination of neuraxial and general anesthesia. 5,[8][9][10] Contrary to other research findings, a post hoc analysis of patients at high risk for cardiovascular complications in the POISE trial showed that patients who received neuraxial blockade were actually at greater risk for cardiovascular complications. 10 We therefore conducted a large population-based study to explore this Ontario who are 65 yr of age or older.…”

contrasting

confidence: 66%

“…5,[8][9][10] Contrary to other research findings, a post hoc analysis of patients at high risk for cardiovascular complications in the POISE trial showed that patients who received neuraxial blockade were actually at greater risk for cardiovascular complications. 10 We therefore conducted a large population-based study to explore this Ontario who are 65 yr of age or older. The ODB database records prescription characteristics, including the drug identification number, the number of days supplied, and the date the prescription was filled.…”

contrasting

confidence: 66%

“…Furthermore, our results may differ from those observed in the analysis of the POISE participants, since the patients in our study were fairly healthy compared with the POISE patients who were at risk for cardiovascular complications. 10 Although, in a post hoc analysis of our data concerning a subgroup of patients with cardiovascular risk factors (or with previous cardiovascular events), we did not find any significant differences between anesthesia type and our primary outcome (Appendix D).…”

Section: Discussionmentioning

confidence: 65%

“…5 Finally, a large post hoc analysis of patients at high risk for cardiovascular complications in the POISE trial found that patients who received neuraxial blockade (whether used alone or in combination) compared with general anesthesia alone were actually at greater risk for cardiovascular complications. 10 It thus remains unclear if neuraxial anesthesia is beneficial when combined with general anesthesia or only when used alone. We restricted our analysis to neuraxial anesthesia combined with general anesthesia rather than isolated neuraxial anesthesia, which may partly explain why we did not find a reduction in the development of major medical outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Combined general and neuraxial anesthesia versus general anesthesia: a population-based cohort study

Nash

Mustafa

McArthur

et al. 2015

Can J Anesth/J Can Anesth

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Purpose To determine whether combining spinal or epidural anesthesia with general anesthesia (combined anesthesia) reduces major medical complications of elective surgery compared with general anesthesia alone. Methods We conducted a propensity-matched population-based historical cohort study using large healthcare databases from Ontario, Canada. We identified patients undergoing 21 different elective procedures that were amenable to either combined anesthesia or general anesthesia alone in 108 hospitals from 2004 to 2011. We assessed the following four outcomes together as a composite and individually in the 30 days following surgery: acute kidney injury, stroke, myocardial infarction, and all-cause mortality. Results Prior to matching, we identified 21,701 patients receiving general anesthesia and 8,042 patients receiving combined anesthesia. After matching, our cohort included Author contributions Danielle M. Nash, Reem A. Mustafa, Sumit Sharan, and Amit X. Garg helped design the study. Duminda N. Wijeysundera contributed to the study design by suggesting operations to focus on and administrative codes/variables to use for the study. J. Michael Paterson contributed to the study design by suggesting administrative codes to use for anesthesia type. Christopher Vinden contributed to the study design by suggesting administrative codes to use to identify epidural insertions. Ron Wald contributed to the study design by providing clinical expertise regarding acute kidney injury. Blayne Welk contributed to the study design by suggesting the additional outcome of length of stay. P.J. Devereaux contributed to the study design by adding clinical expertise regarding cardiovascular events. Reem A. Mustafa developed the preliminary protocol, and Danielle M. Nash completed the study protocol. Danielle M. Nash, Reem A. Mustafa, Eric McArthur, Duminda N. Wijeysundera, J. Michael Paterson, Christopher Vinden, Ron Wald, Blayne Welk, P.J. Devereaux, and Amit X. Garg contributed to the interpretation of results. Daniel I. Sessler contributed to the interpretation of results particularly regarding discussion about intraoperative vs postoperative anesthesia use. Michael Walsh contributed to the interpretation of results particularly regarding the limitations of the study. Sumit Sharan contributed to the interpretation of the results through a dialogue regarding standard practice for epidural catheter insertions. Danielle M. Nash initiated and finalized the manuscript. 123Can J Anesth/J Can Anesth (2015) 62:356-368 DOI 10.1007 12,379 patients. Twenty-eight baseline characteristics were well-matched between the combined (n = 4,773) and general anesthesia groups (n = 7,606 Conclusion L'ajout de la rachianesthésie ou de l'anesthésie péridurale à l'anesthésie générale n'a pas été associé à une diminution du risque de complications médicales majeures pour 21 procédures chirurgicales électives différentes par rapport à l'anesthésie générale administrée seule.Neuraxial anesthesia (epidural and spinal anesthesia) is widely used f...

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contrasting

confidence: 66%

contrasting

confidence: 66%

Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Combined general and neuraxial anesthesia versus general anesthesia: a population-based cohort study

Nash

Mustafa

McArthur

et al. 2015

Can J Anesth/J Can Anesth

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show abstract

“…259 Furthermore, combination of general anaesthesia with thoracic epidural anaesthesia has been shown to statistically increase the risk of arterial hypotension. 260 …”

Section: Neuraxial Techniquesmentioning

confidence: 99%

2014 ESC/ESA Guidelines on Non-cardiac Surgery: Cardiovascular Assessment and Management

Kristensen¹,

Knuuti²,

Saraste³

et al. 2014

Revista Española de Cardiología (English Edition)

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Gastrointestinal Complications After Pancreatoduodenectomy With Epidural vs Patient-Controlled Intravenous Analgesia

et al. 2020

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IMPORTANCEMorbidity is still high in pancreatic surgery, driven mainly by gastrointestinal complications such as pancreatic fistula. Perioperative thoracic epidural analgesia (EDA) and patient-controlled intravenous analgesia (PCIA) are frequently used for pain control after pancreatic surgery. Evidence from a post hoc analysis suggests that PCIA is associated with fewer gastrointestinal complications. OBJECTIVE To determine whether postoperative PCIA decreases the occurrence of gastrointestinal complications after pancreatic surgery compared with EDA.

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Neuraxial block, death and serious cardiovascular morbidity in the POISE trial

Abstract: In patients at high risk of cardiovascular morbidity, neuraxial block was associated with an increased risk of adverse cardiovascular outcomes, which could be causal or because of residual confounding.

Cited by 75 publications

References 29 publications

Combined general and neuraxial anesthesia versus general anesthesia: a population-based cohort study

Combined general and neuraxial anesthesia versus general anesthesia: a population-based cohort study

2014 ESC/ESA Guidelines on Non-cardiac Surgery: Cardiovascular Assessment and Management

Gastrointestinal Complications After Pancreatoduodenectomy With Epidural vs Patient-Controlled Intravenous Analgesia

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