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Comparative Study
. 2024 Aug 1;95(2):365-371.
doi: 10.1227/neu.0000000000002887. Epub 2024 Feb 23.

General Versus Nongeneral Anesthesia for Carotid Endarterectomy: A Prospective Multicenter Registry-Based Study on 25 000 Patients

Victor Gabriel El-Hajj  1 , Abdul Karim Ghaith  2 , Maria Gharios  1 , Kareem El Naamani  3 , Elias Atallah  3 , Steven Glener  3 , Karl John Habashy  4 , Harry Hoang  2 , Saman Sizdahkhani  3 , Nikolaos Mouchtouris  3 , Anand Kaul  3 , Adrian Elmi-Terander  1 , Stavropoula Tjoumakaris  3 , M Reid Gooch  3 , Robert H Rosenwasser  3 , Pascal Jabbour  3
Affiliations
Comparative Study

General Versus Nongeneral Anesthesia for Carotid Endarterectomy: A Prospective Multicenter Registry-Based Study on 25 000 Patients

Victor Gabriel El-Hajj et al. Neurosurgery. .

Abstract

Background and objectives: Carotid endarterectomy (CEA) is a well-established treatment option for carotid stenosis. The choice between general anesthesia (GA) and nongeneral anesthesia (non-GA) during CEA remains a subject of debate, with concerns regarding perioperative complications, particularly myocardial infarctions. This study aimed to evaluate the outcomes associated with GA vs non-GA CEA using a large, nationwide database.

Methods: The National Surgical Quality Improvement Project database was queried for patients undergoing CEA between 2013 and 2020. Primary outcome measures including surgical outcomes and 30-day postoperative complications were compared between the 2 anesthesia methods, after 2:1 propensity score matching.

Results: After propensity score matching, a total of 25 356 patients (16 904 in the GA and 8452 in the non-GA group) were included. Non-GA compared with GA CEA was associated with significantly shorter operative times (101.9, 95% CI: 100.5-103.3 vs 115.8 95% CI: 114.4-117.2 minutes, P < .001), reduced length of hospital stays (2.3, 95% CI: 2.15-2.4 vs 2.5, 95% CI: 2.4-2.6 days, P < .001), and lower rates of 30-day postoperative complications, including myocardial infarctions (0.8% vs 1.2%, P = .003), unplanned intubations (0.8% vs 1.1%, P = .016), pneumonia (0.5% vs 1%, P < .001), and urinary tract infections (0.4% vs 0.7%, P = .003). These outcomes were notably more pronounced in the younger (≤70 years) and high morbidity (American Society of Anesthesiologists 3-5) cohorts.

Conclusion: In this nationwide registry-based study, non-GA CEA was associated with better short-term outcomes in terms of perioperative complications, compared with GA CEA. The findings suggest that non-GA CEA may be a safer alternative, especially in younger patients and those with more comorbidities.

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