AB032. SOH22ABS002. A systematic review and meta-analysis of neuraxial versus general anaesthesia for infra-inguinal revascularization of critical limb ischaemia

Background: Lower limb revascularisation is associated with high rates of perioperative morbidity and mortality. Procedures can be conducted under neuraxial anaesthesia (NA) or general anaesthesia (GA). We conducted a meta-analysis to investigate if one anaesthetic modality was associated with superior outcomes for adults undergoing lower limb revascularisation for critical limb ischemia.

Methods: Electronic databases were searched for randomised and non-randomised studies comparing NA and GA for elective or emergency infra-inguinal endovascular and/or open revascularisation in critical limb ischaemia. The primary outcomes were 30-day mortality, early graft thrombosis, and limb amputation at one-year, secondary outcomes included major adverse cardiovascular events (MACE), stroke, pulmonary and renal events, and tertiary outcomes included rate of post-operative wound infection and total operative time in minutes. Statistical analysis comprised of odds ratios and standardised mean differences using random-effects models.

Results: Eleven studies, involving 15,145 patients, met the inclusion criteria. Meta-analysis of parameters showed statistically significant differences in rates of 30-day mortality [odds ratio (OR): 1.33; 95% confidence interval (CI): 1.16–1.53, P<0.0001], MACE (OR: 0.79; 95% CI: 0.65–0.96, P=0.02), venous thromboembolic events (OR: 0.43; 95% CI: 0.26–0.71, P=0.0008), acute renal failure (OR: 0.62; 95% CI: 0.40–0.96, P=0.03), and wound infection (OR: 0.79; 95% CI: 0.63–0.98, P=0.04). However, after exclusion of a large observational study that demonstrated a skew in data points, no significant differences were ascertained in the sensitivity analysis of the parameters except wound infection. There were no significant differences seen in early graft thrombosis (OR: 1.01, 95% CI: 0.81–1.26, P=0.94) or limb amputation at one-year (OR: 0.80; 95% CI: 0.59–1.07, P=0.13).

Conclusions: Considering the variety of study-types included in this systematic review, a multi-centre randomized control trial is warranted to further explore the difference between these two anaesthetic approaches, if present.

Keywords: Neuraxial anaesthesia (NA); general anaesthesia (GA); lower limb revascularisation; bypass; angioplasty