Anesthetic Technique and Acute Kidney Injury in Endovascular Abdominal Aortic Aneurysm Repair

ObjectivePrior studies suggest that general anesthesia (GA) is associated with worse cardiopulmonary outcomes after endovascular abdominal aortic aneurysm repair (EVAR). Patients undergoing EVAR are at a high risk of developing perioperative acute kidney injury (AKI), and the relationship between anesthetic technique and AKI in these patients is not well-characterized. The authors sought to determine if anesthetic technique affected the risk of AKI in patients undergoing EVAR.DesignRetrospective, observational cohort study analyzed using a multivariate logistic regression model to assess the effects of anesthetic technique on renal outcome.SettingMultiple institutions, mainly in North America.ParticipantsPatients in the American College of Surgeons National Surgical Quality Improvement Program from 2005-2010 undergoing EVAR.InterventionsThe authors investigated the association between anesthetic techniques, comparing GA to alternative (non-GA) techniques, and AKI.Measurements and Main ResultsAKI was defined as an increase in the creatinine level of>2 mg/dL and/or dialysis. Of 13,026 patients, 84.4% underwent GA and 15.6% underwent non-GA techniques. AKI developed in 2.0% of the GA group and 1.4% of the non-GA group (unadjusted odds ratio [OR] 1.43, p = 0.075; adjusted OR [aOR] 1.00, p = 0.99). Risk factors for AKI include ASA class, ruptured aneurysm, preoperative renal dysfunction, symptomatic cardiovascular disease, and perioperative blood transfusion.ConclusionsAnesthetic technique is not independently associated with the risk of AKI in patients undergoing EVAR.