Miller Brady L, Abel E Jason, Allen Glenn, Schumacher Jessica R, Jarrard David, Downs Tracy, Richards Kyle A
Department of Urology, University of Wisconsin Madison, WI 53792.
Department of Surgery, University of Wisconsin Madison, WI 53792.
Am J Clin Exp Urol. 2020 Feb 25;8(1):28-37. eCollection 2020.
Epidural anesthesia is used to improve pain control after major surgeries. Few data describe the impact of epidural use for bladder cancer patients treated with radical cystectomy (RC). Here, we evaluate epidural use on perioperative and long-term outcomes for patients treated with radical cystectomy for bladder cancer. Patients who received radical cystectomy for non-metastatic bladder urothelial carcinoma with epidural (n=1,748) and without epidural (n=6,109) anesthesia from 2002-2014 were identified using Surveillance, Epidemiology and End Results-Medicare data. Radical cystectomy outcomes with and without epidural anesthesia were compared using propensity score weighting. Epidural use at time of radical cystectomy was identified in 1,748 (22.2%) of 7,857 patients who met inclusion criteria. After propensity score weighted adjustment, epidural use was associated with increased 30-day readmission (29.6% vs. 26.2%, P<0.001), increased median length of stay in days (9.0, IQR 7.0-12.0 vs 8.0, IQR 6.0-12.0, P<0.01), and decreased likelihood of being discharged directly to home without need for home health or skilled nursing care (21.6% vs 29.1%, P<0.001). Post-operative MI (2.6% vs 1.3%, P<0.001) in the first 30 days after radical cystectomy was more common in the epidural group, but perioperative 30-day mortality was similar (3.3% vs 2.9%, P=0.21). Epidural use was not associated with increased cancer specific (HR 0.96, 0.90-1.02, P=0.20) or overall survival (HR 0.99, 0.95-1.04, P=0.73). Epidural use at time of radical cystectomy is associated with increased risk of perioperative complications, hospital readmission, and longer hospitalization without improving disease specific survival. Prospective studies are needed to confirm these findings.
硬膜外麻醉用于改善大手术后的疼痛控制。很少有数据描述硬膜外麻醉对接受根治性膀胱切除术（RC）的膀胱癌患者的影响。在此，我们评估硬膜外麻醉对膀胱癌根治性膀胱切除术患者围手术期和长期结局的影响。利用监测、流行病学和最终结果-医疗保险数据，确定了2002年至2014年期间接受非转移性膀胱尿路上皮癌根治性膀胱切除术且接受硬膜外麻醉（n = 1748）和未接受硬膜外麻醉（n = 6109）的患者。使用倾向评分加权比较有和没有硬膜外麻醉的根治性膀胱切除术结局。在符合纳入标准的7857例患者中，1748例（22.2%）在根治性膀胱切除术时使用了硬膜外麻醉。经过倾向评分加权调整后，使用硬膜外麻醉与30天再入院率增加相关（29.6%对26.2%，P<0.001），中位住院天数增加（9.0，四分位数间距7.0 - 12.0对8.0，四分位数间距6.0 - 12.0，P<0.01），以及无需家庭健康护理或专业护理而直接出院回家的可能性降低（21.6%对29.1%，P<0.001）。根治性膀胱切除术后前30天内的术后心肌梗死（2.6%对1.3%，P<0.001）在硬膜外麻醉组中更常见，但围手术期30天死亡率相似（3.3%对2.9%，P = 0.21）。硬膜外麻醉的使用与癌症特异性生存率增加（风险比0.96，0.90 - 1.02，P = 0.20）或总生存率增加（风险比0.99，0.95 - 1.04，P = 即需要前瞻性研究来证实这些发现。 73）无关。根治性膀胱切除术时使用硬膜外麻醉与围手术期并发症、医院再入院风险增加以及住院时间延长相关，而未改善疾病特异性生存率。需要前瞻性研究来证实这些发现。
