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Comparative Study
. 2015 Sep;210(3):483-91.
doi: 10.1016/j.amjsurg.2015.04.009. Epub 2015 Jun 2.

A nationwide analysis of the use and outcomes of perioperative epidural analgesia in patients undergoing hepatic and pancreatic surgery

Neda Amini  1 , Yuhree Kim  1 , Omar Hyder  2 , Gaya Spolverato  1 , Christopher L Wu  3 , Andrew J Page  1 , Timothy M Pawlik  4
Affiliations
Comparative Study

A nationwide analysis of the use and outcomes of perioperative epidural analgesia in patients undergoing hepatic and pancreatic surgery

Neda Amini et al. Am J Surg. 2015 Sep.

Abstract

Background: We sought to define trends in the use of epidural analgesia (EA) for hepatopancreatic procedures, as well as to characterize inpatient outcomes relative to the use of EA.

Methods: The Nationwide Inpatient Sample database was queried to identify all elective hepatopancreatic surgeries between 2000 and 2012. In-hospital outcomes were compared among patients receiving EA vs conventional analgesia using propensity matching.

Results: EA utilization was 7.4% (n = 3,961). The use of EA among minimally invasive procedures increased from 3.8% in 2000 to 9.1% in 2012. The odds of sepsis (odds ratio [OR] .72, 95% confidence interval [CI] .56 to .93), respiratory failure (OR .79, 95% CI .69 to .91), and postoperative pneumonia (OR .77, 95% CI .61 to .98), as well as overall in-hospital mortality (OR .72, 95% CI .56 to .93) were lower in the EA cohort (all P < .05). In contrast, no association was noted between EA and postoperative hemorrhage (OR .81, 95% CI .65 to 1.01, P = .06).

Conclusions: EA use among patients undergoing hepatopancreatic procedures remains low. After controlling for confounding factors, EA remained associated with a reduction in specific pulmonary-related complications, as well as in-hospital mortality.

Keywords: Epidural analgesia; Liver resection; Outcome; Pancreatic resection.

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Figures

Figure 1
Figure 1
Relative use rate of EA over time stratified by receipt of MIS vs open surgery.
Figure 2
Figure 2
Relative use rate of EA stratified by procedure type.
Figure 3
Figure 3
Length of hospital stay according to anesthesiology type.
Figure 4
Figure 4
Percent of patients experiencing a complication including inpatient mortality according to anesthesia type among MIS and open surgery.
See this image and copyright information in PMC

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