The Type of Anesthesia Technique Does Not Have an Impact on 30-Day Mortality in Geriatric Patients Undergoing Lower Extremity Amputation

Abstract

This study aimed to determine the appropriate anesthetic technique for patients who underwent amputation due to peripheral vascular disease. The anesthetic technique to be applied during lower extremity amputations in geriatric patients with limited functional capacity may be important in terms of clinical outcomes and mortality rates. Patients aged older than 65 years who had undergone major lower extremity amputation were retrospectively evaluated. The patients were divided into 2 groups: regional anesthesia (RA) and general anesthesia (GA). Demographic characteristics, comorbidities, medications used, anesthesia technique, the durations of anesthesia and surgery, need for blood transfusion, 30-day mortality, postoperative cardiac and pulmonary complication rates were recorded from the medical records of the patients. Among the 441 patients, 244 had received RA, while 197 had received GA. The average length of stay in the hospital was longer in the GA group (P ¼ 0.001). The use of antiplatelet drugs (P ¼ 0.001) and the number of transfusions were higher (P ¼ 0.045) in the GA group. No

Effects of regional anaesthesia on mortality in patients undergoing lower extremity amputation: A retrospective pooled analysis

“…[ 11 12 ] Out of the 10 studies, two did not control for confounders. [ 13 14 ] The rest of the studies utilised either multivariate logistic regression[ 12 15 16 17 ] or propensity score matching[ 4 11 18 19 ] to adjust for confounders. With the exception of one study which was reported by SA Khan et al ,[ 4 ] all of the eight studies that controlled for confounders reported no significant benefit of RA over GA in reducing the incidence of 30-day mortality after LEA [ Table 2 ].…”

“…Six studies[ 4 12 13 14 15 17 ] reported the length of hospital stay (H-LOS). There is some evidence that H-LOS is shorter in patients who received RA compared to GA. Three studies[ 13 14 15 ] reported a statistically significant shorter H-LOS with the use of RA with mean differences ranging between 3.7 to 5 days. [ 13 15 ]…”

“…[ 14 ] Two studies reported ICU admission as an outcome measure. Both these studies reported a significantly lower ICU admission (by 52.1%[ 11 ] and 84%[ 13 ]) in the RA group compared to the GA group. Among the patients who were admitted to the ICU, RA and GA were associated with similar durations of ICU stay.…”

“…Cardiac outcomes appear to be similar between the RA and GA groups. Six[ 11 13 14 15 16 22 ] out of seven[ 11 12 13 14 15 16 22 ] studies reported no differences in the incidences of myocardial infarction between the RA and GA groups. A study by Dittman et al .…”

“…There is evidence that RA does not result in reduced incidences of pneumonia,[ 11 13 14 15 13 18 22 ] pulmonary embolism,[ 12 13 15 16 ] prolonged ventilation,[ 11 3 15 19 ] hypoxia[ 11 ] and unplanned intubation. [ 11 19 ] A study utilising a composite pulmonary outcome yielded similar results.…”