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The following is a summary of “Anesthesia techniques for vitreoretinal surgery in the united states: A report from the multicenter perioperative Outcomes Group Research Consortium,” published in the June 2024 issue of Ophthalmology by Chauhan et al.

Anesthesia is used during vitreoretinal (VR) surgeries in academic and community hospitals across the U.S. 

Researchers conducted a retrospective study to understand the influence and patterns of anesthesia use and determinants during VR surgery. 

They used the Multicenter Perioperative Outcomes Group (MPOG) database of 107,066 patients undergoing VR surgeries. Patients were over 18 years old and had either monitored anesthesia care (MAC) or general anesthesia (GA) (January 1, 2015-December 31, 2021). Patient-level, case-based, and institutional-level covariates were collected, and multivariate mixed-effects models were used to predict the type of anesthesia. As a secondary outcome, MAC cases were further classified based on the additional use of sedation into MAC with or without sedation. 

The results showed that 67.45% of VR surgeries used MAC, with over 73.63% of hospitals favoring MAC in most cases. About 47.76% of the MAC variation was due to where the surgery took place. MAC use went up with age but decreased in patients with certain conditions like drug abuse and chronic pulmonary or liver disease. Conversely, patients with alcohol abuse, diabetes complications, or higher American Society of Anesthesiologists (ASA) status (4 or more vs. 1, 2, or 3) were more likely to get MAC. Complex surgeries like PPV or SB for retinal detachment saw less MAC use compared to non-complex ones, PPV (P=0.004), PPV+ scleral buckle (SB) (P<0.0001), and primary SB surgery (P<0.0001).

Investigators concluded a 2/3 preference for MAC in most VR surgeries, but GA takes the lead when it comes to SBs, complex vitrectomies, and younger patients. Significant differences in MAC use between institutions were found.

Source: ajo.com/article/S0002-9394(24)00253-8/abstract#%20