Key result
Aortic stenosis was significantly associated with an increased risk of 30-day in-hospital mortality (aOR 1.31) and major postoperative complications compared to patients without aortic stenosis undergoing noncardiac surgery.
Why the study?
Whether aortic stenosis increases perioperative risk in noncardiac surgery remains controversial, and limited information is available regarding adequate anesthetic techniques for these patients.
Does aortic stenosis increase the risk of adverse outcomes in patients undergoing noncardiac surgery, and does general anesthesia pose a higher risk than neuraxial anesthesia in AS patients?
Cohort (n=19,482)
Does aortic stenosis increase the risk of adverse outcomes in patients undergoing noncardiac surgery, and does general anesthesia pose a higher risk than neuraxial anesthesia in AS patients?
Odds Ratio: 1.31 (95% CI 1.03–1.67)
Absolute Event Rate: 1.6% vs 1.3%
Aortic stenosis is an independent risk factor for adverse events after noncardiac surgery, and neuraxial anesthesia is associated with fewer postoperative complications than general anesthesia in these patients, challenging the traditional view that neuraxial anesthesia is contraindicated.
Whether aortic stenosis (AS) increases perioperative risk in noncardiac surgery remains controversial. Limited information is available regarding adequate anesthetic techniques for patients with AS. Using the reimbursement claims data of Taiwan's National Health Insurance, we performed propensity score matching analyses to evaluate the risk of adverse outcomes in patients with or without AS undergoing noncardiac surgery between 2008 and 2013. We also compared the perioperative risk of AS patients undergoing general anesthesia or neuraxial anesthesia. Multivariable logistic regressions were applied to calculate the adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for postoperative mortality and major complications. The matching procedure generated 9741 matched pairs for analyses. AS was significantly associated with 30-day in-hospital mortality (aOR 1.31, 95% CI 1.03-1.67), acute renal failure (aOR 1.42, 95% CI 1.12-1.79), pneumonia (aOR 1.16, 95% CI 1.02-1.33), stroke (aOR 1.14, 95% CI 1.01-1.29), and intensive care unit stay (aOR 1.38, 95% CI 1.27-1.49). Compared with neuraxial anesthesia, general anesthesia was associated with increased risks of acute myocardial infarction (aOR 3.06, 95% CI 1.22-7.67), pneumonia (aOR 1.80, 95% CI 1.32-2.46), acute renal failure (aOR 1.82, 95% CI 1.11-2.98), and intensive care (aOR 4.05, 95% CI 3.23-5.09). The findings were generally consistent across subgroups. AS was an independent risk factor for adverse events after noncardiac surgery. In addition, general anesthesia was associated with greater postoperative complications in AS patients compared to neuraxial anesthesia. This real-world evidence suggests that neuraxial anesthesia should not be contraindicated in patients with AS.
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Tai et al. (2021) conducted a cohort in Aortic stenosis in patients undergoing noncardiac surgery (n=19,482). Aortic stenosis vs. No aortic stenosis was evaluated on 30-day in-hospital mortality (aOR 1.31, 95% CI 1.03-1.67). Aortic stenosis was significantly associated with an increased risk of 30-day in-hospital mortality (aOR 1.31) and major postoperative complications compared to patients without aortic stenosis undergoing noncardiac surgery.
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