Journal CME - 2016 January
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Journal CME - 2016 January

Journal CME - 2016 January


Background: Surgical resection remains the best option for long-term survival in many solid tumors. Surgery can, however, lead to tumor cell release into the circulation. Data have suggested differential effects of anesthetic agents on cancer cell growth. This retrospective analysis investigated the association of anesthetic technique with long-term survival in patients
presenting for elective surgery in a comprehensive cancer center over 3 yr.

Methods: All patients undergoing elective surgery between June 2010 and May 2013 were included. Patients were grouped according to whether they had received volatile inhalational (INHA) or total IV anesthesia (TIVA). After excluding those who received both forms of anesthesia during the study period, Kaplan–Meier survival curves were constructed from the date of surgery to death.
After propensity matching, univariate and multivariable regression models were used to compare hazard ratios for death.

Results: A total of 11,395 anesthetics using INHA or TIVA were delivered in the study period. After exclusions, 3,316 patients (796 deaths, 24%) remained in the INHA group and 3,714 (504 deaths, 13.5%) in the TIVA group. After propensity matching, 2,607 patients remained in each group (597 deaths, 22.8%, in INHA group vs. 407, 15.6%, in TIVA group). Volatile inhalational anesthesia was associated with a hazard ratio of 1.59 (1.30 to 1.95) for death on univariate analysis
and 1.46 (1.29 to 1.66) after multivariable analysis of known confounders in the matched group.

Conclusions: This retrospective analysis demonstrates an association between type of anesthetic delivered and survival. This analysis alongside biological plausibility should lead to urgent prospective work exploring the effect of anesthetic technique on survival.

CME Credit: 1.00 AMA PRA Category 1 Credit™

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Learning Objectives:
After successfully completing this activity, the learner will be able to do the following:

  1. Recognize physiologic factors that may contribute to increased tumor growth. (1,2)

  2. Develop an overall risk estimate (hazard ratio) for mortality within 3 years based on known risk...

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