Octogenarians Fair Better Under Local Anesthesia for Elective Endovascular Aortic Aneurysm Repair.

INTRODUCTION: With aging patient population, an increasing number of octogenarians are undergoing elective Endovascular Abdominal Aortic Aneurysm Repair (EVAR) in the US. Multiple studies have shown that for general population, use of local anesthetic for EVAR is associated with improved short-term and long-term outcomes as compared to performing these operations under general anesthesia. Therefore, this study aimed to study the association of local anesthesia for elective EVARs with perioperative outcomes, among octogenarians.

METHODS: The Vascular Quality Initiative database (2003-2021) was used to conduct this study. Octogenarians (Aged ≥ 80) were selected and sorted into two study groups: Local Anesthesia (Group I) and General Anesthesia (Group II). Our primary outcomes were length of stay (LOS) and mortality. Secondary outcomes included operative time, estimated blood loss, return to OR, cardiopulmonary complications, and discharge location.

RESULTS: Of the 16,398 selected patients, 1,197 patients (7.3%) were included in Group I, and 15,201 patients (92.7%) were in Group II. Procedural time was significantly shorter for the local anesthetic group (114.6 vs. 134.6, p<0.001), as was estimated blood loss (152cc vs. 222cc, p<0.001). Length of stay was significantly shorter (1.8 days vs. 2.6 days, p<0.001), and patients were more likely to be discharged home (LA 88.8% vs. GA 86.9%, p=0.036) in the local anesthesia group. Group I also experienced fewer pulmonary complications; only 0.17% experienced pneumonia and 0.42% required ventilator support compared to 0.64% and 1.02% in Group II, respectively. This finding corresponded to fewer days in the ICU for group I (0.41 vs. 0.69, p<0.001). No significant difference was seen in 30-day mortality cardiac, renal, or access-site-related complications. Return to OR was also equivocal between the two groups. Multivariate regression analysis confirmed GA was associated with a significantly longer LOS and significantly higher rates of non-home discharge (AOR 1.59, p<0.001 and 1.40, p=0.025, respectively). When stratified by the New York Heart Association classification system, classes I, II, III, and IV (1.55, p<0.001, 1.26, p=0.029 2.03, p<0.001, 4.07, p<0.001respectively) were associated with significantly longer hospital stays.

CONCLUSION: The use of local anesthesia for EVARs in octogenarians is associated with shorter lengths of stay, fewer respiratory complications, and home discharge. These patients also experienced shorter procedure times and less blood loss. There was no statistically significant difference in 30-day mortality, return to operating room, access-related complications. Local anesthesia for octogenarians undergoing EVAR should be considered more frequently to shorten hospital stays and decrease complication rates.