Summary of findings for the main comparison. Neuraxial versus general anaesthesia for lower‐limb revascularization.
| Neuraxial versus general anaesthesia for lower‐limb revascularization | ||||||
| Patient or population: participants with lower‐limb revascularization Settings: Intervention: Neuraxial versus general anaesthesia | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Neuraxial versus general anaesthesia | |||||
| Mortality－At any time | Study population | OR 0.89 (0.38 to 2.07) | 696 (4 studies) | ⊕⊕⊝⊝ low1 | ||
| 43 per 1000 | 38 per 1000 (17 to 85) | |||||
| Medium‐risk population | ||||||
| 55 per 1000 | 49 per 1000 (22 to 108) | |||||
| Myocardial infarction－Spinal anaesthesia | Study population | OR 1.89 (0.5 to 7.21) | 306 (2 studies) | ⊕⊕⊝⊝ low1,2 | ||
| 25 per 1000 | 46 per 1000 (13 to 156) | |||||
| Medium‐risk population | ||||||
| 24 per 1000 | 44 per 1000 (12 to 151) | |||||
| Myocardial infarction－Epidural anaesthesia | Study population | OR 0.98 (0.37 to 2.58) | 390 (3 studies) | ⊕⊕⊝⊝ low1,2 | ||
| 50 per 1000 | 49 per 1000 (19 to 120) | |||||
| Medium‐risk population | ||||||
| 44 per 1000 | 43 per 1000 (17 to 106) | |||||
| Amputation rate－Spinal anaesthesia | Study population | OR 1.04 (0.35 to 3.06) | 235 (2 studies) | ⊕⊕⊝⊝ low1,2 | ||
| 71 per 1000 | 74 per 1000 (26 to 190) | |||||
| Medium‐risk population | ||||||
| 69 per 1000 | 72 per 1000 (25 to 185) | |||||
| Amputation rate－Epidural anaesthesia | Study population | OR 0.66 (0.21 to 2.07) | 230 (2 studies) | ⊕⊕⊝⊝ low1,2 | ||
| 81 per 1000 | 55 per 1000 (18 to 154) | |||||
| Medium‐risk population | ||||||
| 79 per 1000 | 54 per 1000 (18 to 151) | |||||
| Pneumonia | Study population | OR 0.37 (0.15 to 0.89) | 201 (2 studies) | ⊕⊝⊝⊝ very low2,3,4 | ||
| 196 per 1000 | 83 per 1000 (35 to 178) | |||||
| Medium‐risk population | ||||||
| 196 per 1000 | 83 per 1000 (35 to 178) | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; OR: Odds ratio. | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate Very low quality: We are very uncertain about the estimate | ||||||
1 All trials recruited participants from elective surgery and did not define criteria for participants with high risk, moderate risk or low risk. Authors did not describe blinding. In Christopherson 1993, the cardiologists assessing cardiac outcomes were blinded to the group to which participants were allocated. Christopherson 1993, Cook 1986 and Dodds 2007 included few participants. 2 In Christopherson 1993, the rate of missing data was described as 3.1% in the intervention group and 1.9% in the control group. Cook 1986 reported that 11/50 intervention participants and 4/51 control participants were lost to follow‐up. Dodds 2007 did not report mortality during one‐year follow up. Bode 1996 reported complete data collection for non‐surgical outcomes during hospitalization in 423 participants. However, surgical outcomes over 30 postoperative days were reported for only 264 participants (159 missing). 3Cook 1986 described that more elderly participants and smokers were allocated to the general anaesthesia group and that this can influenced results 4 In Cook 1986, participants were analysed during hospital stay