Anesthetic Choice for Cardiovascular Implantable Electronic Device Placement and Lead Removal: A National Anesthesia Clinical Outcomes Registry Analysis
Authors' conclusion
General anesthesia still has a strong presence in the anesthetic management of both CIED placement and transvenous lead removal. Anesthetic choice, however, varies with patient demographics, hospital characteristics, and geographic region.
Study context
- Population
- Adults undergoing cardiovascular implantable electronic device (CIED) (permanent pacemaker or ICD) placement or transvenous lead removal, 2010–2021, National Anesthesia Clinical Outcomes Registry
- Participants
- 87,530 / 76,140 / 2,568 / 4,861
- Exposure
- MAC vs GA for CIED placement and transvenous lead removal
- Pacemaker placementn = 87,530
- ICD placementn = 76,140
- Pacemaker lead removaln = 2,568
- ICD lead extractionn = 4,861
- Outcome
- Anesthetic type (MAC vs GA) and its predictors
Methodological detailsregistry analysis, multivariate models
- Registry analysis
- Multivariate models
Main finding
As reported in the abstract
Proportion receiving MAC
Observational data: associations, not effects.
Further findings
Predictors of MAC: age (per 1-year increase)
- Increase in MAC, pacemaker placement (p < 0.0001)
- 2%
- Increase in MAC, ICD placement (p < 0.0001)
- 1%
- Increase in MAC, pacemaker lead removal (p = 0.0003)
- 2%
Predictors of MAC: American Society of Anesthesiologists (ASA) physical status
- ASA ≤III more likely to receive MAC, pacemaker placement (p = 0.0013)
- 7%
- ASA ≥IV more likely to receive MAC, ICD placement (p = 0.0144)
- 5%
- ASA ≤III more likely to receive MAC, pacemaker lead removal (p = 0.0247)
- 27%
Predictors of MAC: region
- Northeast more likely to receive MAC than West for all groups (p < 0.0024)
Predictors of MAC: sex
- Male less likely to receive MAC for pacemaker lead removal (p = 0.0378)
- 24%
Predictors of MAC: annual lead removal volume (per 10 additional)
- Decrease in MAC, pacemaker lead removal (p = 0.0271) and ICD lead removal (p < 0.0001)
- 2%
Original publication
Anesthetic Choice for Cardiovascular Implantable Electronic Device Placement and Lead Removal: A National Anesthesia Clinical Outcomes Registry Analysis. J Cardiothorac Vasc Anesth. Published 29 July 2023. doi:10.
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