General anesthesia was associated with a significantly higher risk of 30-day all-cause mortality compared to local anesthesia in patients with PAH (4.6% vs. 3.5%; HR 1.32; p<0.001).
Cohort (n=41,694)
Yes
Does general anesthesia increase mortality compared to local anesthesia in adult patients with pulmonary arterial hypertension undergoing procedures?
In patients with pulmonary arterial hypertension, general anesthesia is associated with a higher risk of mortality and postoperative vasopressor support up to 6 months compared to local anesthesia.
Effect estimate: HR 1.32
Absolute Event Rate: 4.6% vs 3.5%
p-value: p=<0.001
Abstract Rationale Patients with Pulmonary Arterial hypertension (PAH) face a substantial risk of perioperative morbidity and mortality. The optimal anesthetic strategy, general anesthesia (GA) versus local anesthesia (LA), and its impact on short and long-term outcomes remain poorly defined. This study aimed to compare postoperative outcomes at multiple time points between these two anesthetic modalities in a large, real-world cohort of patients with PAH. Methods A retrospective cohort study was conducted using the TriNetX global federated health research network. We identified adult patients with a diagnosis of primary or secondary PAH, confirmed by the use of specific PAH-targeted medications, who underwent a procedure with either GA or LA. To control for baseline differences, the cohorts were balanced using 1:1 propensity-score matching. Key outcomes, including all-cause mortality, right heart failure exacerbation, vasopressor use, hospital readmission, and initiation of IV prostacyclin, were assessed at 30, 90, and 180 days post-procedure. Results We identified an initial cohort of 21,283 PAH patients receiving general anesthesia (GA) and 24,890 receiving local anesthesia (LA). After 1:1 propensity-score matching, 20,847 patients remained in each cohort. General anesthesia was associated with a significantly higher risk of all-cause mortality at all time points: at 30 days (4.6% vs. 3.5%; HR 1.32; p 0.001), at 90 days (7.3% vs. 6.1%; HR 1.215; p 0.001), and at 180 days (9.9% vs. 8.9%; HR 1.13; p 0.001). The requirement for postoperative vasopressor support was also significantly higher in the GA group at 30 days (3.9% vs. 3.5%; HR 1.13; p = 0.026), 90 days (HR 1.15; p = 0.004), and 180 days (HR 1.1; p = 0.02). At all evaluated time points, there were no significant differences in the rates of right heart failure exacerbation, all-cause readmission, or new IV prostacyclin use. Conclusion In this large, propensity-score matched analysis of patients with Pulmonary Arterial Hypertension, general anesthesia was associated with a higher risk of mortality through 6 months compared to local anesthesia. This finding suggests that, when clinically feasible for the planned procedure, selecting a local or regional anesthetic technique may be a critical strategy to improve long-term survival in this high-risk patient population. This abstract is funded by: none
Tated et al. (Fri,) conducted a cohort in Pulmonary Arterial Hypertension (n=41,694). General anesthesia vs. Local anesthesia was evaluated on All-cause mortality at 30 days (HR 1.32, p=<0.001). General anesthesia was associated with a significantly higher risk of 30-day all-cause mortality compared to local anesthesia in patients with PAH (4.6% vs. 3.5%; HR 1.32; p<0.001).