Regional anesthesia is associated with improved mortality and morbidity in patients with congestive heart failure undergoing lower extremity amputation

Mohamad Chahrour; Hassan Chamseddine; Loay Kabbani; Maen Aboul Hosn

doi:10.1016/j.avsg.2024.04.019

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Regional anesthesia is associated with improved mortality and morbidity in patients with congestive heart failure undergoing lower extremity amputation

Journal article

Peer reviewed

Regional anesthesia is associated with improved mortality and morbidity in patients with congestive heart failure undergoing lower extremity amputation

Mohamad Chahrour, Hassan Chamseddine, Loay Kabbani and Maen Aboul Hosn

Annals of vascular surgery, Vol.108, pp.206-211

11/2024

DOI: 10.1016/j.avsg.2024.04.019

PMID: 38950851

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Abstract

While existing literature reports variable results of general anesthesia (GA) and regional anesthesia (RA) in patients undergoing lower extremity amputation (LEA), the effect of RA on patients with congestive heart failure (CHF) has not been explored. This study aims to assess whether the choice of anesthesia plays a role in influencing outcomes within this vulnerable population. Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) files between 2005-2022, all patients receiving LEA were identified, and the subset of patients with CHF was included. Patient characteristics and 30-day outcomes were compared using χ2 or Fischer’s exact test as appropriate for categorical variables and the independent t-test or Mann-Whitney U test as appropriate for continuous variables. The association between anesthesia modality and post-operative outcomes was studied using multivariable logistic regression analysis. A total of 5,831 patients (4,779 undergoing GA, 1,052 undergoing RA) with a diagnosis of CHF undergoing LEA were identified. On multivariable logistic regression analysis, RA was associated with lower mortality (aOR 0.79, 95% CI 0.65-0.97), pneumonia (aOR 0.76, 95% CI 0.58-0.99), septic shock (aOR 0.64, 95% CI 0.47-0.88), post-operative blood transfusion (aOR 0.82, 95% CI 0.70-0.97), and 30-day readmission (aOR 0.79, 95% CI 0.64-0.97). This study demonstrates that RA for LEA in patients with CHF is associated with decreased morbidity and mortality compared to GA. While further research is needed to confirm this association, RA should be at least considered in CHF patients undergoing LEA when feasible.

Amputation

Anesthesia

Congestive Heart Failure

NSQIP

Details

Title: Subtitle: Regional anesthesia is associated with improved mortality and morbidity in patients with congestive heart failure undergoing lower extremity amputation
Creators: Mohamad Chahrour - University of Iowa
Hassan Chamseddine - University of Iowa Hospitals and Clinics
Loay Kabbani - Henry Ford Hospital
Maen Aboul Hosn - Division of Vascular Surgery, Department of Surgery, University of Iowa Hospital and Clinics, Iowa, USA
Resource Type: Journal article
Publication Details: Annals of vascular surgery, Vol.108, pp.206-211
DOI: 10.1016/j.avsg.2024.04.019
PMID: 38950851
NLM abbreviation: Ann Vasc Surg
ISSN: 0890-5096
eISSN: 1615-5947
Publisher: Elsevier Inc
Language: English
Electronic publication date: 06/29/2024
Date published: 11/2024
Academic Unit: Surgery
Record Identifier: 9984652260102771

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