Anaesthetic specialisation leads to improved early- and medium-term survival following major vascular surgery

Eur J Vasc Endovasc Surg. 2010 Jun;39(6):719-25. doi: 10.1016/j.ejvs.2010.02.004. Epub 2010 Mar 11.

Abstract

Objective: Vascular surgical specialisation is associated with improved outcomes. We aimed to assess the effect of anaesthetic specialisation on outcome following major vascular surgery.

Design: Retrospective cohort study.

Methods: Patients undergoing major vascular surgery (lower limb revascularisation, elective and ruptured abdominal aortic aneurysm repair, endovascular aneurysm repair and carotid endarterectomy) over a five-year period were identified from a prospective database. The primary outcomes were death within 30 days and death within two years of surgery. Potential risk factors for mortality were assessed using multivariate logistic regression modelling.

Results: The analysis cohort comprised 1155 patients followed up for a median of 583 days. Mortality within two years of surgery was 16%. For the overall cohort, care from vascular anaesthetists was independently associated with reduced 30-day (odds ratio 0.22; 95% CI 0.12-0.62) and medium-term mortality (0.31; 95% CI 0.18-0.55). For elective patients (n=851), vascular anaesthesia reduced two-year mortality (odds ratio 0.29; 95% CI 0.15-0.58; P=0.0004) though not 30-day mortality (odds ratio 0.55; 95% CI 0.15-1.95; P=0.35). For emergency patients, care by a vascular anaesthetist influenced neither 30-day mortality (odds ratio 0.33; 95% CI 0.08-1.41; P=0.13) nor medium-term mortality (odds ratio 0.45; 95% CI 0.17-1.21; P=0.11).

Conclusions: Anaesthetic specialisation reduced early- and medium-term mortality rates following major vascular surgery. If replicated by prospective studies, these results suggest that vascular surgery services would benefit from specialised anaesthetic support.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Anesthesia / standards*
  • Anesthesiology / education*
  • Confidence Intervals
  • Education, Medical, Continuing / standards*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Odds Ratio
  • Postoperative Period
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Survival Rate / trends
  • Time Factors
  • Vascular Diseases / mortality
  • Vascular Diseases / surgery*
  • Vascular Surgical Procedures / mortality*