Use of neuraxial anesthesia for hybrid lower extremity revascularization is associated with reduced perioperative morbidity

Fereydooni, Arash; O'Meara, Tess A.; Popescu, Wanda M.; Dardik, Alan; Chaar, Cassius Iyad Ochoa

doi:10.1016/j.jvs.2019.07.072

Cited by 10 publications

(6 citation statements)

References 28 publications

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“…Patients undergoing lower limb revascularization surgery for PAD are at high risk of serious postoperative adverse events and consume substantial health care resources. We hypothesize that avoidance of general anesthesia may represent an efficacious approach to improving their health outcomes and reducing resource use [ 1 , 2 , 11 , 12 ]. Use of neuraxial or regional anesthesia instead of general anesthesia could improve outcomes after lower limb revascularization surgery in several biologically plausible ways.…”

Section: Discussionmentioning

confidence: 99%

“…Use of neuraxial (spinal or epidural) or regional (peripheral nerve block) anesthesia instead of general anesthesia may represent one approach to improving postoperative health outcomes and reducing resource use among patients undergoing lower limb revascularization surgery for PAD [1,2,11,12]. Both neuraxial and regional anesthesia improve peripheral circulation and avoid mechanical ventilation, while neuraxial anesthesia improves coagulation and blunts surgical stress responses [1,[13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

“…A 2013 Cochrane systematic review of four small randomized controlled trials (RCTs) reported that patients who received neuraxial instead of general anesthesia for lower limb revascularization surgery had a lower pooled risk of pneumonia [ 18 ]. An increasing number of large nonrandomized comparative studies have also recently reported that use of neuraxial or regional anesthesia (instead of general anesthesia) is associated with variable reductions in adjusted perioperative cardiopulmonary and renal complications, lengths of hospital stay, in-hospital or short-term mortality, and health care system costs [ 1 , 3 , 11 , 12 , 19 ]. However, reported findings of these studies are inconsistent and some remain limited by a risk of residual confounding by indication [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

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Outcomes After Receipt of Neuraxial or Regional Anesthesia Instead of General Anesthesia for Lower Limb Revascularization Surgery: Protocol for a Systematic Review and Meta-analysis

Roberts¹,

Dreksler²,

Nagpal³

et al. 2021

JMIR Res Protoc

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Background Patients undergoing lower limb revascularization surgery for peripheral artery disease (PAD) have a high risk of perioperative morbidity and mortality and often have long hospital stays. Use of neuraxial or regional anesthesia instead of general anesthesia may represent one approach to improving outcomes and reducing resource use among these patients. Objective The aim is to conduct a systematic review and meta-analysis to determine whether receipt of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD results in improved health outcomes and costs and a shorter length of hospitalization. Methods We will search electronic bibliographic databases (MEDLINE, EMBASE, the seven databases in Evidence-Based Medicine Reviews, medRxiv, bioRxiv, and Google Scholar), review papers identified during the search, and included article bibliographies. We will include randomized and nonrandomized studies comparing the use of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD. Two investigators will independently evaluate the risk of bias. The primary outcome will be short-term (in-hospital or 30-day) mortality. Secondary outcomes will include longer-term mortality; major adverse cardiovascular, pulmonary, renal, and limb events; delirium; deep vein thrombosis or pulmonary embolism; neuraxial or regional anesthesia–related complications; graft-related outcomes; length of operation and hospital stay; costs; and patient-reported or functional outcomes. We will calculate summary odds ratios (ORs) and standardized mean differences (SMDs) using random-effects models. Heterogeneity will be explored using stratified meta-analyses and meta-regression. We will assess for publication bias using the Begg and Egger tests and use the trim-and-fill method to estimate the potential influence of this bias on summary estimates. Finally, we will use Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology to make an overall rating of the quality of evidence in our effect estimates. Results The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO). We executed the peer-reviewed search strategy on March 2, 2021. We completed the review of titles and abstracts on July 30, 2021, and plan to complete the review of full-text papers by September 30, 2021. We will complete full-text study data extraction and the risk-of-bias assessment by November 15, 2021, and conduct qualitative and then quantitative data synthesis and GRADE assessment of results by January 1, 2022, before drafting the manuscript. We anticipate that we will be able to submit the manuscript for peer review by the end of February 2022. Conclusions This study will synthesize existing evidence regarding whether receipt of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD results in improved health outcomes, graft patency, and costs and a shorter length of hospital stay. Study results will be used to inform practice and future research, including creation of a pilot and then multicenter randomized controlled trial. Trial Registration Prospero CRD42021237060; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=237060 International Registered Report Identifier (IRRID) PRR1-10.2196/32170

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Outcomes After Receipt of Neuraxial or Regional Anesthesia Instead of General Anesthesia for Lower Limb Revascularization Surgery: Protocol for a Systematic Review and Meta-analysis

Roberts¹,

Dreksler²,

Nagpal³

et al. 2021

JMIR Res Protoc

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

“…A 2013 Cochrane systematic review of four small randomized controlled trials (RCTs) reported that patients who received neuraxial instead of general anesthesia for lower limb revascularization surgery had a lower pooled risk of pneumonia [18]. An increasing number of large nonrandomized comparative studies have also recently reported that use of neuraxial or regional anesthesia (instead of general anesthesia) is associated with variable reductions in adjusted perioperative cardiopulmonary and renal complications, lengths of hospital stay, in-hospital or short-term mortality, and health care system costs [1,3,11,12,19]. However, reported findings of these studies are inconsistent and some remain limited by a risk of residual confounding by indication [1].…”

Section: Introductionmentioning

confidence: 99%

Outcomes After Receipt of Neuraxial or Regional Anesthesia Instead of General Anesthesia for Lower Limb Revascularization Surgery: Protocol for a Systematic Review and Meta-analysis (Preprint)

Roberts¹,

Dreksler²,

Nagpal³

et al. 2021

Preprint

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BACKGROUND Patients undergoing lower limb revascularization surgery for peripheral artery disease (PAD) have a high-risk of perioperative morbidity and mortality and often have long hospital stays. Use of neuraxial or regional anesthesia instead of general anesthesia may represent one approach to improving outcomes and reducing resource use among these patients. OBJECTIVE To conduct a systematic review and meta-analysis to determine whether receipt of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD results in improved health outcomes and costs and a shorter length of hospitalization. METHODS We will search electronic bibliographic databases (MEDLINE, EMBASE, and the seven databases in Evidence-Based Medicine Reviews), review articles identified during the search, and included article bibliographies. We will include randomized and non-randomized studies comparing use of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD. Two investigators will independently evaluate risk of bias. The primary outcome will be short-term mortality (in-hospital or 30-day). Secondary outcomes will include longer-term mortality; major adverse cardiovascular, pulmonary, and renal events; delirium; deep vein thrombosis or pulmonary embolism; major adverse limb events; neuraxial or regional anesthesia-related complications; graft-related outcomes; length of operation and hospital stay; costs; and patient-reported or functional outcomes. We will calculate summary odds ratios and standardized mean differences using random-effects models. Heterogeneity will be explored using stratified meta-analyses and meta-regression. We will assess for publication bias using Begg’s and Egger’s tests and use the trim-and-fill method to estimate the potential influence of this bias on summary estimates. Finally, we will use Grading of Recommendations, Assessment, Development, and Evaluation methodology to make an overall rating of the quality of evidence in our effect estimates. RESULTS The protocol was registered in PROSPERO, the international register of systematic reviews. CONCLUSIONS This study will synthesize existing evidence regarding whether receipt of neuraxial or regional anesthesia instead of general anesthesia in adults undergoing lower limb revascularization surgery for PAD results in improved health outcomes, graft patency, and costs, and a shorter length of hospital stay. Study results will be used to inform practice and future research, including creation of a pilot and then multicenter randomized controlled trial. CLINICALTRIAL PROSPERO CRD42021237060.

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Cross-leg free flaps and cross-leg vascular cable bridge flaps for lower limb salvage: experience before and after COVID-19

Ciudad¹,

Escandón

Manrique

et al. 2023

Eur J Plast Surg

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Use of neuraxial anesthesia for hybrid lower extremity revascularization is associated with reduced perioperative morbidity

Cited by 10 publications

References 28 publications

Outcomes After Receipt of Neuraxial or Regional Anesthesia Instead of General Anesthesia for Lower Limb Revascularization Surgery: Protocol for a Systematic Review and Meta-analysis

Outcomes After Receipt of Neuraxial or Regional Anesthesia Instead of General Anesthesia for Lower Limb Revascularization Surgery: Protocol for a Systematic Review and Meta-analysis

Outcomes After Receipt of Neuraxial or Regional Anesthesia Instead of General Anesthesia for Lower Limb Revascularization Surgery: Protocol for a Systematic Review and Meta-analysis (Preprint)

Cross-leg free flaps and cross-leg vascular cable bridge flaps for lower limb salvage: experience before and after COVID-19

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