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Background and Aims Thoracic surgery is associated with a high incidence of PPCs. Despite advancements in surgical technique, pulmonary complications due to pain are the most common cause of morbidity. Our study examined the association between anesthetic technique and PPCs after VATS lobectomy(Video Assisted Thoracoscopic surgery).
Methods This study was determined to be exempt from University of Virginia ethics committee review. National American College of Surgeons National Surgical Quality Improvement Program database was searched for VATS lobectomy cases from 2017 to 2021. Cases were stratified into four groups– GA alone, GA + local, GA + Regional, and GA + Epidural. Generalized linear regression models were used to examine the effect of anesthetic technique on study’s primary outcome-any occurrence of PPC(pneumonia, reintubation, or postoperative ventilation >48 hours). The secondary outcome was length of stay(LOS).
Results A total of 15,084 cases were identified and 14,477 cases met study inclusion. The 4 groups had PPC rate between 3.5-5.2%. There was no statistically significant difference in the odds of PPCs when an additional anesthesia technique was added to GA (figure 1). As compared to GA alone group, LOS was significantly lower in the regional and local group by 7.8% and 8.6% respectively(both ps < 0.001-figure 2).The epidural group had longer LOS by 16%(p < 0.001).
PPC and anesthesia technique
Anesthesia technique and length of stay
Conclusions Our results suggest that addition of regional or local anesthesia is associated with reduced LOS after VATS lobectomy. However, their use was not associated with lower PPCs. Further research into other areas of risk reduction for these patients is needed to continue to improve outcomes.
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