Elsharydah Ahmad, Zuo Leila W, Minhajuddin Abu, Joshi Girish P
Department of Anesthesiology and Pain Management (Elsharydah, Zuo, Minhajuddin, Joshi) and Department of Clinical Sciences (Minhajuddin), The University of Texas Southwestern Medical Center, Dallas, Texas.
Proc (Bayl Univ Med Cent). 2017 Jul;30(3):255-258. doi: 10.1080/08998280.2017.11929608.
The use of epidural analgesia (EA) has been suggested as an integral part of an enhanced recovery program for colorectal surgery. However, the effects of EA on postoperative outcomes and hospital length of stay remain controversial. Data from the American College of Surgeons National Surgical Quality Improvement Program database for 2014 and 2015 were queried for adult patients who underwent elective open colorectal surgery. We included only cases with general anesthesia as the main anesthetic. Cases with other types of anesthesia were excluded. A 1:3 matched sample of EA versus non-EA cases was created based on propensity scores. The primary outcome of interest was the occurrence of major cardiopulmonary complications within 7 days of the surgery. Secondary outcome measures were hospital length of stay and 30-day mortality. A total of 24,927 patients were included in the analysis. EA was utilized in 15.02% (n = 3745). The cumulative risk over the study period for major cardiopulmonary complications was 2.52% (n = 627). There were no statistically significant differences in the rate of postoperative complications (relative risk 0.91, 95% CI 0.66-1.27, = 0.59), length of stay (median [interquartile range], EA 6 [5-9] versus non-EA 6 [4-9] days, = 0.36), and 30-day mortality rate (relative risk 0.71, 95% CI 0.42-1.20, = 0.20) between the two propensity-matched cohorts. In conclusion, our study revealed that the benefits of EA in patients undergoing open colorectal surgery are limited, as it does not influence immediate postoperative cardiopulmonary complications or hospital length of stay.
硬膜外镇痛（EA）的使用已被建议作为结直肠手术强化康复计划的一个组成部分。然而，EA对术后结局和住院时间的影响仍存在争议。查询了美国外科医师学会国家外科质量改进计划数据库2014年和2015年的数据，以获取接受择期开放性结直肠手术的成年患者。我们仅纳入以全身麻醉作为主要麻醉方式的病例，排除其他类型麻醉的病例。根据倾向评分创建了EA组与非EA组1:3的匹配样本。感兴趣的主要结局是术后7天内发生的主要心肺并发症。次要结局指标为住院时间和30天死亡率。共有24927例患者纳入分析，其中15.02%（n = 3745）使用了EA。研究期间主要心肺并发症的累积风险为2.52%（n = 627）。两组倾向匹配队列在术后并发症发生率（相对风险0.91，95%可信区间0.66 - 1.27，P = 0.59）、住院时间（中位数[四分位间距]，EA组6[5 - 9]天，非EA组6[4 - 9]天，P = 0.36）和30天死亡率（相对风险0.71，95%可信区间0.42 - 1.20，P = 0.20）方面均无统计学显著差异。总之，我们的研究表明，EA对接受开放性结直肠手术患者的益处有限，因为它不影响术后即刻心肺并发症或住院时间。
