title: Postoperative analgesia reduces mortality and morbidity after esophagectomy.
abstract: BACKGROUND
  To study the influence of postoperative analgesia on morbidity and mortality after esophagectomy.
  
  
  METHODS
  The outcomes of 578 patients who underwent one-stage resection between 1986 and 1995 were analyzed. Patients who received either epidural morphine, patient-controlled analgesia, or continuous intravenous morphine infusion supervised by an anesthesiology-based acute pain service (group APS, n = 299) were compared with those for whom conventional intramuscular meperidine injections were used (group CON, n = 279).
  
  
  RESULTS
  For patients who underwent transthoracic esophagectomy, group APS (n = 226) had a lower incidence of pulmonary complications (13% versus 25%, P = 0.002), cardiovascular complications (21% versus 43%, P < 0.001), and hospital mortality (8% versus 14%, P = 0.038) when compared with group CON (n = 189). No similar difference was demonstrated in patients who underwent esophagectomy without thoracotomy. The hospital stay (days) was shorter in group APS than in group CON for both transthoracic esophagectomy (22 +/- 20 versus 30 +/- 37, P = 0.005) and nontransthoracic esophagectomy patients (19 +/- 13 versus 25 +/- 21, P = 0.029).
  
  
  CONCLUSIONS
  Adequate postoperative analgesia is associated with lower cardiopulmonary complications, lower mortality and reduced cost in patients undergoing transthoracic esophagectomy.
authors.affiliation: Department of Anesthesiology, University of Hong Kong, Queen Mary Hospital.
authors.forename: S L
authors.initials: SL
authors.lastname: Tsui
authors.forename: S
authors.initials: S
authors.lastname: Law
authors.forename: M
authors.initials: M
authors.lastname: Fok
authors.forename: J R
authors.initials: JR
authors.lastname: Lo
authors.forename: E
authors.initials: E
authors.lastname: Ho
authors.forename: J
authors.initials: J
authors.lastname: Yang
authors.forename: J
authors.initials: J
authors.lastname: Wong
mesh_terms: D000698:Analgesia / Q000379:methods; D016058:Analgesia, Patient-Controlled; D016629:Esophagectomy / Q000009:adverse effects* / Q000401:mortality*; D005260:Female; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D007275:Injections, Intravenous; D007902:Length of Stay; D008171:Lung Diseases / Q000209:etiology; D008297:Male; D008614:Meperidine / Q000008:administration & dosage; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D011182:Postoperative Care; D016896:Treatment Outcome
chemical_list: D009020:Morphine; D008614:Meperidine