Epilepsy Risk Associated with the Receipt of General Anesthesia Relative to Neuraxial Anesthesia
Abstract number :
3.146
Submission category :
16. Epidemiology
Year :
2024
Submission ID :
102
Source :
www.aesnet.org
Presentation date :
12/9/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: R Grace Couper, MSc – Western University
Tresah Antaya, MPH – Western University
Melody Lam, MSc – ICES Western
Philip Jones, MD – Mayo Clinic
Miguel Arango, MD – Western University
Mauricio Giraldo, MD – Western University
Jorge Burneo, MD, MSPH, FAAN, FAES, FRCPC – Western University, London Ontario Canada
Rationale: Recent evidence suggests that the receipt of general anesthesia may be associated with an increased risk of epilepsy compared with neuraxial (spinal or epidural) anesthesia. Therefore, our study objective was to estimate the risk of developing new-onset epilepsy associated with the receipt of general anesthesia relative to neuraxial anesthesia.
Methods: We conducted a population-based retrospective cohort study using linked health administrative databases in Ontario, Canada. Participants who had an eligible surgical procedure with general or neuraxial anesthesia between April 1, 2007, and March 31, 2015, were included and followed for up to five years. Eligible surgical procedures included gynecological, lower extremity, peripheral vascular, and urological procedures that could be performed using general or neuraxial anesthesia. Patients with epilepsy or epilepsy risk factors in the ten years before their surgical procedure were excluded. We used inverse probability of treatment weighting to control for confounding and Fine-Gray subdistribution models to estimate the hazard ratio for epilepsy, accounting for the competing risk of death.
Results: The final sample included 100,547 patients who received general anesthesia and 76,644 patients who received neuraxial anesthesia. After weighting, the estimated event rates of epilepsy were 48.8 and 35.5 per 100,000 person-years for the general and neuraxial anesthesia cohorts, respectively. The hazard ratio for epilepsy associated with general anesthesia was 0.61 (95% CI 0.34-1.07). However, there was evidence that risk changed over the five-year follow-up period (interaction HR=1.36, 95% CI 1.12-1.64). This led to a significantly increased risk of epilepsy associated with general anesthesia after approximately three years.
Conclusions: Our results suggest that general anesthesia may be associated with an increased risk of epilepsy after three or more years; however, our findings are likely impacted by other factors, such as unmeasured differences between the anesthesia cohorts, types of surgical procedures, and the occurrence of epilepsy risk factors during the follow-up period. Future research should explore whether there is effect modification between specific surgical procedures and control for the onset of epilepsy risk factors after anesthesia receipt.
Funding: This study was funded by the Jack Cowin Endowed Chair in Epilepsy Research at Western University.
Epidemiology