Center for Surgical Science, Zealand University Hospital, Koege, Denmark.
Clinical Pharmacology and Pharmacy, Odense University Hospital, Odense, Denmark.
Acta Anaesthesiol Scand. 2022 Aug;66(7):869-879. doi: 10.1111/aas.14101. Epub 2022 Jun 27.
In colorectal cancer, surgical resection is fundamental for curative treatment. Epidural analgesia mitigates the perioperative physiologic stress response caused by surgery, and reduction in perioperative stress may reduce postoperative complications. Nevertheless, epidural analgesia also causes hypotension and lower limb motor weakness that can impair postoperative recovery. Here, we aimed to assess the association between epidural analgesia and postoperative complications after colorectal cancer surgery.
We identified patients undergoing colorectal cancer surgery 2008-2018 in Denmark in the Danish Colorectal Cancer Group Database and obtained anaesthesia data from the Danish Anaesthesia Database. The Danish National Prescription Registry was used to obtain data on prescriptions filled preoperatively reflecting current comorbidities. Databases were linked using the Danish Central Person Registry number and the operation day. Patients were classified according to preoperative insertion of an epidural catheter for analgesia. Confounders were adjusted by propensity score matching. Logistic regression was used to compute effect estimates of epidural analgesia on postoperative complications.
We identified 19 932 individuals undergoing colorectal cancer surgery with available anaesthesia data. Propensity score matching yielded 5691 individuals in each group with balanced preoperative covariates. In the epidural analgesia group 1400 (24.6%) experienced complications compared with 1453 (25.5%) without epidural analgesia. We found no statistically significant association between epidural use and postoperative complications (OR 0.95, 95% CI 0.87-1.04).
In total, in this observational study based on Danish registries, we found no association between epidural analgesia and postoperative complications after colorectal cancer surgery.
在结直肠癌中，手术切除是治愈治疗的基础。硬膜外镇痛减轻手术引起的围手术期生理应激反应，减少围手术期应激可能减少术后并发症。然而，硬膜外镇痛也会导致低血压和下肢运动无力，从而影响术后恢复。在这里，我们旨在评估硬膜外镇痛与结直肠癌手术后并发症之间的关联。
我们在丹麦的丹麦结直肠癌组数据库中确定了 2008 年至 2018 年期间接受结直肠癌手术的患者，并从丹麦麻醉数据库中获取了麻醉数据。丹麦国家处方登记处用于获取反映当前合并症的术前处方数据。使用丹麦中央人员登记处号码和手术日将数据库链接。根据术前插入硬膜外导管进行镇痛的情况对患者进行分类。通过倾向评分匹配调整混杂因素。使用逻辑回归计算硬膜外镇痛对术后并发症的影响估计。
我们确定了 19932 名接受结直肠癌手术且有可用麻醉数据的个体。倾向评分匹配产生了每组 5691 名具有平衡术前协变量的个体。在硬膜外镇痛组中，有 1400 人（24.6%）经历了并发症，而没有硬膜外镇痛的有 1453 人（25.5%）。我们发现硬膜外使用与术后并发症之间没有统计学显著关联（OR 0.95，95%CI 0.87-1.04）。
在这项基于丹麦登记处的观察性研究中，我们总体上没有发现硬膜外镇痛与结直肠癌手术后并发症之间的关联。
