Key result
Sedation cuts in-hospital mortality ~32% vs. general anesthesia during percutaneous procedures.
Why the study?
The comparative impact of sedation versus general anesthesia on all-cause mortality remains a subject of ongoing debate.
Does sedation reduce all-cause mortality compared to general anesthesia in patients undergoing percutaneous procedures?
Meta-Analysis (n=61,945)
Does sedation reduce all-cause mortality compared to general anesthesia in patients undergoing percutaneous procedures?
Effect estimate: RR 0.68 (95% CI 0.58-0.79)
p-value: p=<0.001
Sedation may be superior to general anesthesia in reducing in-hospital and 30-day mortality for patients undergoing percutaneous procedures, particularly cardiac and macrovascular surgeries.
Sedation may be preferred over general anesthesia to reduce in-hospital mortality in percutaneous procedures; extends evidence particularly to cardiac and macrovascular interventions.
BACKGROUND: The comparison between sedation and general anesthesia (GA) in terms of all-cause mortality remains a subject of ongoing debate. The primary objective of our study was to investigate the impact of GA and sedation on all-cause mortality in order to provide clarity on this controversial topic. METHODS: A systematic review and meta-analysis were conducted, incorporating cohort studies and RCTs about postoperative all-cause mortality. Comprehensive searches were performed in the PubMed, EMBASE, and Cochrane Library databases, with the search period extending until February 28, 2023. Two independent reviewers extracted the relevant information, including the number of deaths, survivals, and risk effect values at various time points following surgery, and these data were subsequently pooled and analyzed using a random effects model. RESULTS: A total of 58 studies were included in the analysis, with a majority focusing on endovascular surgery. The findings of our analysis indicated that, overall, and in most subgroup analyses, sedation exhibited superiority over GA in terms of in-hospital and 30-day mortality. However, no significant difference was observed in subgroup analyses specific to cerebrovascular surgery. About 90-day mortality, the majority of studies centered around cerebrovascular surgery. Although the overall pooled results showed a difference between sedation and GA, no distinction was observed between the pooled ORs and the subgroup analyses based on RCTs and matched cohort studies. For one-year all-cause mortality, all included studies focused on cardiac and macrovascular surgery. No difference was found between the HRs and the results derived from RCTs and matched cohort studies. CONCLUSIONS: The results suggested a potential superiority of sedation over GA, particularly in the context of cardiac and macrovascular surgery, mitigating the risk of in-hospital and 30-day death. However, for the longer postoperative periods, this difference remains uncertain. TRIAL REGISTRATION: PROSPERO CRD42023399151; registered 24 February 2023.
No takes yet. Share an insight, caveat, or question.
Su et al. (2024) conducted a meta-analysis in Percutaneous procedures (n=61,945). Sedation vs. General anesthesia was evaluated on In-hospital all-cause mortality (RR 0.68, 95% CI 0.58-0.79, p=<0.001). Sedation significantly reduced the risk of in-hospital all-cause mortality compared to general anesthesia in patients undergoing percutaneous procedures (RR 0.68).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: