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 PS110. Anesthesia Type and Outcomes Following Lower Extremity Amputations

​Michael R. Buckley1, Thomas D. Conlee1, Jeanette Andrews3, Christopher J. Godshall1, Justin B. Hurie1, Randolph L. Geary1, Kimberley J. Hansen1, Noel Harrington2, Matthew S. Edwards1
1Wake Forest Medical Center Department of Vascular and Endovascular Surgery, Winston-Salem, NC; 2Wake Forest Medical Center Department of Anesthesiology, Winston-Salem, NC; 3Wake Forest Medical School Department of Biostatistical Sciences, Winston-Salem, NC.

OBJECTIVES: The purpose of this study is to compare types of anesthesia in major lower extremity amputations (LEA) in order to determine whether one type is superior to another in terms of morbidity and mortality

METHODS: Major LEAs performed between 2005 and 2008 were identified from the American College of Surgeons National Surgical Quality Improvement Program database (ACS-NSQIP) using CPT codes. Anesthesia was defined as general or regional (epidural, spinal or other regional). Patient-level co-morbidities and characteristics, as well as intraoperative and postoperative details were examined. Complications were analyzed individually, and in aggregate categories. Procedure-specific variables, length of stay (LOS), and 30-day mortality were examined. Characteristics and outcomes were described using mean±SD or count (%) and associations with anesthesia type were evaluated for statistical significance. Associations between morbidity and mortality and anesthesia type were examined using uni- and multivariable logistic and linear regression techniques.

RESULTS: A total of 1,592 LEAs were identified for analysis. Of these, general anesthesia was employed in 1,294 (81%) of these cases. Mean patient age was 68±14 years, 61% were men, and 66% were white. Overall, the 30-day mortality was 6.5% (104), any type morbidity occurred in 24.1% (383), while the mean LOS was 5 (3, 7) days. There was no statistical difference in the type of surgeon performing the amputations (85% vascular surgeons overall) between the types of anesthesia. No univariate differences were observed by anesthesia type in terms of procedural specifics, LOS or the occurrence of morbidity (individual or aggregate) or mortality. Multivariate analyses also demonstrated no relationship between anesthesia type and the occurrence of overall morbidity or mortality.

CONCLUSIONS: In contemporary surgical practice, based on outcomes of morbidity and mortality, there appears to be no difference in anesthesia type when major LEAs are performed.

AUTHOR DISCLOSURES: J. Andrews, Nothing to disclose; M. R. Buckley, Nothing to disclose; T. D. Conlee, Nothing to disclose; M. S. Edwards, Nothing to disclose; R. L. Geary, Nothing to disclose; C. J. Godshall, Nothing to disclose; K. J. Hansen, Nothing to disclose; N. Harrington, Nothing to disclose; J. B. Hurie, Nothing to disclose.

Posted April 2012

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