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Below is a summary of “Anesthetic Techniques for Vitreoretinal Surgery in the United States: A Report of the Multicenter Perioperative Outcomes Group Research Consortium,” published in the June 2024 issue of Ophthalmology by Chauhan et al.

Anesthesia is used for vitreoretinal (VR) surgery in academic and community hospitals throughout the United States.

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

They used the Multicenter Perioperative Outcomes Group (MPOG) database of 107,066 patients who underwent VR surgery. Patients were over 18 years of age and had either monitored anesthesia (MAC) or general anesthesia (GA) (January 1, 2015 – December 31, 2021). Patient-level, case-level, 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 into MAC with or without sedation based on the additional use of sedation.

The results showed that MAC was used in 67.45% of VR surgeries, with over 73.63% of hospitals preferring MAC in most cases. About 47.76% of the MAC variation was due to the location where the surgery took place. MAC use increased with age, but decreased in patients with certain medical conditions such as substance abuse and chronic lung or liver disease. Conversely, patients with alcohol abuse, diabetes complications, or a higher ASA status (4 or more versus 1, 2, or 3) were more likely to have MAC. In complex surgeries such as PPV or SB for retinal detachment, MAC was used less than in non-complex surgeries, PPV (P=0.004), PPV+ scleral buckle (SB) (PP

The researchers concluded that for most VR surgeries, 2/3 prefer MAC, but for SBs, complex vitrectomies, and younger patients, GA prevails. Significant differences in MAC usage were found between institutions.

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