Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH.
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
Ann Surg. 2018 May;267(5):971-976. doi: 10.1097/SLA.0000000000002214.
We aimed to evaluate the association of epidural analgesia (EA) with hospital length of stay (LOS), wound morbidity, postoperative complications, and patient-reported outcomes in patients undergoing ventral hernia repair (VHR).
EA has been shown to reduce LOS in certain surgical populations. The LOS benefit in VHR is unclear.
Patients having VHR performed in the Americas Hernia Society Quality Collaborative (AHSQC) were separated into 2 comparable groups matched on several confounding factors using a propensity score algorithm: one group received postoperative EA, and the other did not. The groups were then evaluated for hospital LOS, 30-day wound morbidity, other complications, and 30-day patient-reported outcomes using pain and hernia-specific quality-of-life instruments.
A 1:1 match was achieved and the final analysis included 763 patients receiving EA and 763 not receiving EA. The EA group had an increased LOS (5.49 vs 4.90 days; P < 0.05). The rate of wound events was similar between the groups. There was an increased risk of having any postoperative complication associated with having EA (26% vs 21%; P < 0.05). Pain intensity-scaled scores were significantly higher (worse) in the EA group versus the non-EA group (47.6 vs 44.0; P = 0.04).
The LOS benefit of EA noted for other operations may not apply to patients undergoing VHR. Further study is necessary to determine the beneficial role of invasive pain management procedures in this group of patients with an extremely common disease state.
我们旨在评估硬膜外镇痛（EA）与住院时间（LOS）、伤口发病率、术后并发症和患者报告的结果在接受腹疝修复（VHR）患者中的相关性。
EA 已被证明可减少某些手术人群的 LOS。VHR 中的 LOS 优势尚不清楚。
使用倾向评分算法，将在美国疝协会质量协作组（AHSQC）中接受 VHR 的患者分为两组：一组接受术后 EA，另一组不接受。然后，通过疼痛和疝特异性生活质量工具评估两组的住院 LOS、30 天伤口发病率、其他并发症和 30 天患者报告的结果。
实现了 1:1 匹配，最终分析包括 763 例接受 EA 和 763 例未接受 EA 的患者。EA 组的 LOS 增加（5.49 天 vs. 4.90 天；P < 0.05）。两组的伤口事件发生率相似。与接受 EA 相关的任何术后并发症的风险增加（26% vs. 21%；P < 0.05）。与非 EA 组相比，EA 组的疼痛强度评分显著更高（更差）（47.6 对 44.0；P = 0.04）。
其他手术中观察到的 EA 的 LOS 优势可能不适用于接受 VHR 的患者。需要进一步研究确定在这群患有极其常见疾病状态的患者中，侵入性疼痛管理程序的有益作用。
