Epidural anesthesia reduces length of hospitalization after endoluminal abdominal aortic aneurysm repair

Purpose: The low invasiveness of endoluminal abdominal aneurysm repair (EAA R) appears optimal for the use of epidural anesthesia (EA). However, report ed series on EAAR show that general anesthesia (GA) is generally preferred. To evaluate the feasibility and problems encountered with EA for EAAR, pat ients undergoing EAAR with EA and patients undergoing EAAR with GA were exa mined. Methods: From April 1997 through October 1998, EAAR was performed on 119 pa tients at the Unit of Vascular Surgery at Policlinico Monteluce in Perugia, Italy. Four patients (3%) required conversion to open repair and were excl uded from the analysis because they were not suitable candidates for evalua ting the feasibility of EA. The study cohort thus comprised 115 patients un dergoing abdominal aortic aneurysm (AAA) repair with the AneuRx Medtronic s tent graft. The incidence of risk factors and anatomical features of the an eurysm were compared in patients selected for EA or GA on the basis of inte ntion-to-treat analysis. Intraoperative and perioperative data were compare d and analyzed on the basis of intention-to-treat and on-treatment analysis . Results: Sixty-one patients (54%) underwent the surgical procedure with EA (group A), and 54 (46%) underwent the surgical procedure with GA (group B). Conversion from EA to GA was required in four patients (3 of 61 patients, 5%). There were no statisti cally significant differences beween the two st udy groups in demographics, clinical characteristics, and American Society of Anesthesiology classification (ASA). There was no perioperative mortalit y. Major morbidity occurred in 3% of patients (group B). According to inten tion-to-treat analysis, no significant differences were observed between th e two groups in mean operating time, fluoro time, blood loss, amount of con trast media used, mean units of transfused blood, need of intensive care un it, mean postoperative hospital stay, and postoperative endoleak. Conversel y, significant differences were found by means of on-treatment analysis in the need of intensive care unit (0 vs 5 patients; P = .02), and length of h ospitalization (2.5 vs 3.2 days; P = .04). Multivariate logistic regression analysis showed that GA and ASA 4 were positive independent predictors of prolonged (more than 2 days) postoperative hospitalization (hazard ratio, 2 .5; 95% CI, 1.1 to 5.8; P = .03, and hazard ratio, 5.1; 95% CI, 1.5 to 17.9 ; P = .007, respectively). Conclusion: EA for EAAR is feasible in a high percentage of patients in who m it is attempted, and it ensures a technical outcome comparable with that of patients undergoing EAAR with GA. Successful completion of EAAR with EA is associated with a short period of hospitalization.