Outcomes after Receipt of Neuraxial or Regional Anesthesia Instead of General Anesthesia for Lower Limb Revascularization Surgery: A Systematic Review and Meta-Analysis

We sought to determine whether the receipt of neuraxial or regional anesthesia instead general in adults undergoing lower limb revascularization surgery results differences health outcomes and length hospital stay. searched MEDLINE, EMBASE, Evidence-Based Medicine Reviews, identified review articles, reviewed article reference lists for randomized nonrandomized studies comparing use surgery. Two us independently extracted data evaluated risk bias. calculated summary odds ratios standardized mean using DerSimonian Laird random effects models. Among 6509 citations identified, we included 5 (n = 970 patients) 12 73,840 (Table). The was associated with a nonsignificant decrease 30-day mortality (pooled ratio [OR], 0.77; 95% confidence interval [CI], 0.33-1.80; five studies) significant adjusted OR, 0.61; CI, 0.31-0.92; two studies; Fig). patients allocated had pulmonary complications 0.37; 0.17-0.81; studies). In studies, cardiopulmonary renal (OR, 0.73; 0.63-0.85; one study), myocardial infarction 0.56; 0.40-0.77; pneumonia 0.65; 0.30-1.00; studies), venous thromboembolism 0.42; 0.24-0.73; acute kidney injury 0.48; 0.33-0.63; Neuraxial also pooled difference stay across eight (−0.11; −0.01 −0.21). Nonrandomized suggested that neuraxial, general, is decreased perioperative shorter stay.TableCharacteristics studiesStudy; countryData sourceRecruitmentMean age, yearsInterventionPatients, No.Patient characteristics, %Surgical procedures, %Follow-up, monthsNA/RAGAUrgent emergentTypeRandomized Dodds et al, 2007; USASingle centerNR67.9Epidural3745CAD (28), DM (61), CKD (NR), CTLI (NR)0Femoral–above knee bypass (6); femoral–below (94)12 Pierce 1997; center1988-9167.6Spinal epidural16896CAD (36), (85), CLTI (84)0Femoral–distal (100)1 Bode 1996; center1988-9168Spinal epidural285138CAD (36) (86), Christopherson 1993; center1988-9165Epidural4951CAD (27), (35), (NR)0NR6 Cook 1986; AustraliaSingle centerNR66.8Spinal5051CAD (9), (NR)NRNR12Nonrandomized Bisgaard 2021; DenmarkDanish Vascular Registry2005-1771.0Spinal epidural685010509CAD (54)3.2Inguinal infrainguinal reconstruction; femoral–distal (45)NR Roberts 2020; CanadaICES2002-1569.7Spinal epidural645314535CAD (13), (45), (8), (NR)12.4Infrainguinal bypass, endarterectomy, patch angioplasty, thromboembolectomyNR Fereydooni USANSQIP2005-1772.1Spinal epidural4528631CAD (33), (7), (34)5.1Hybrid proceduresNR 2019; USANSQIP2005-1770.8Local peripheral nerve block3508631CAD (37), (4), (35)10.0Hybrid Sgroi USAVQI2011-1667.3Spinal epidural57215425CAD (31), (56), (100)1.3Femoropopliteal (42); (43); popliteal–distal (10)12 Kikuchi JapanSingle center2012-1771.7Ultrasound-guided block67137CAD (79), (55), (100)NRFemoral–distal ± endovascular interventionNR Wiis 2014; DenmarkSingle center2000-1071.1Epidural389499CAD (10), (NR)18.5Infrainguinal bypass; (29)NR Ghanami 2013; USANSQIP2005-868.7Spinal epidural6944768CAD (49), (78)0Femoral–popliteal (49) (51)1 Singh 2006; USANSQIP1995-200365.8Spinal epidural50319757CAD (44), (NR)NRFemoral–popliteal (56) (36)1 Schunn 1998; center1989-94NREpidural145158CAD (58), (86)NRFemoral–popliteal (58) (42)NR Rivers 1991Single center1986-9069Epidural96117CAD (67), (86)NRFemoral–distal (100)NR Manolio 1989Single center1983-8563.7Spinal epidural7856CAD (26), (NR)8.2NRNRCAD, Coronary artery disease; CKD, chronic CLTI, limb-threatening ischemia; DM, diabetes mellitus; GA, anesthesia; ICES, Institute Clinical Evaluative Services; NA/RA, (neuraxial defined as local anesthetic applied nerves central nervous system [eg, spinal epidural anesthesia]; femoral block]); NR, not reported; NSQIP, National Surgical Quality Improvement Program; VQI, Initiative. Open table new tab