Abstract 165: Total Intravenous Anesthesia as Compared to Volatile Anesthesia is Associated with Reduced Length of Stay After Transcatheter Aortic Valve Replacement: Results From Two-Year Program at Major Academic Medical Center
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Abstract 165: Total Intravenous Anesthesia as Compared to Volatile Anesthesia is Associated with Reduced Length of Stay After Transcatheter Aortic Valve Replacement: Results From Two-Year Program at Major Academic Medical Center
Beschreibung:
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<jats:bold>Background:</jats:bold>
Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement in patients with severe, symptomatic aortic stenosis who are at least intermediate risk for surgery. As TAVR has evolved, more emphasis has been placed on reducing hospital length of stay (LOS) following the procedure. Therefore, we sought to identify whether changes in the general anesthetic technique, specifically using total intravenous anesthesia (TIVA) versus volatile anesthesia (VA), would lead to reductions in hospital LOS.
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<jats:bold>Methods:</jats:bold>
A retrospective review was conducted of 67 consecutive patients at a single institution who underwent TAVR under general anesthesia (GA) with either TIVA or VA between November 2014 and July 2016. Hospital LOS, as well as patient demographics, intraoperative, and postoperative risk factors for prolonged hospital LOS were analyzed. Descriptive statistics were conducted using Fisher’s exact and Student’s t-test. Risk factors for LOS were assessed using unadjusted linear regression.
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<jats:bold>Results:</jats:bold>
Data were analyzed from 67 TAVR patients with a mean age of 78 ± 9 years. The patient population was 43% female (29/67), 88% Caucasian (59/67), with a mean ± SD aortic valve gradient of 42 ± 17 mmHg with an ejection fraction of 53 ± 13 %. Of the 67 patients, 35 received TIVA (52%) and 32 received VA (48%). The majority of patients in both the TIVA and VA group underwent TAVR with a transfemoral approach (29/35, 83% vs. 24/32, 75%, p=0.55). Patients receiving TIVA had a shorter hospital LOS (3.7 ± 2.6 days vs. 5.9 ± 3.3 days, p=0.003) and shorter ICU LOS (1.5 ± 0.8 days vs. 2.7 ± 2.0 days, p=0.004) as compared to patients receiving VA. For every hour increase in anesthesia time, hospital LOS was increased by 0.92 days (p=0.02). Patients receiving GA with propofol infusion had a reduction in hospital LOS by 1.9 days (p=0.02) and a reduction in ICU LOS by 1 day (p=0.009) as compared to patients who received VA with desflurane.
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<jats:bold>Conclusions:</jats:bold>
Reducing hospital LOS following TAVR is a complex and multifactorial problem. Our study suggests that anesthetic technique, the particular mix of drugs used for GA, and the time under GA all play a role in determining the hospital LOS. This finding can influence refinements in the techniques used to care for patients undergoing TAVR and may help us continue to reduce hospital LOS following TAVR.
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