title: Postoperative epidural analgesia following elective major abdominal surgery in high risk patients: a retrospective cohort study.
abstract: OBJECTIVE
  To describe the effect of post-operative epidural analgesia on morbidity and mortality rates in a group of high-risk patients undergoing elective major abdominal surgery.
  
  
  METHODS
  Retrospective chart review of patients in American Society of Anaesthetists Physical Status (ASA) category III or IV, who underwent elective major I or II general surgical procedures between 01/01/1996 and 01/09/1998. Patients were identified from a prospective audit database. Patients who had epidural analgesia or conventional parenteral opioids were compared for outcome measures.
  
  
  RESULTS
  There were 167 patients identified (72 epidural, 95 non-epidural group). There was no significant difference in demographic data, inpatient stay, intensive care unit stay, or mortality rates (11% epidural v 17% non-epidural, p>0.05). There was no significant difference in morbidity rates, however there was a non-significant trend towards a lower morbidity in the epidural group.
  
  
  CONCLUSIONS
  This study does not show any benefit from post-operative epidural analgesia on morbidity and mortality rates in high risk patients undergoing major abdominal surgery. It does illustrate that ASA 3 and 4 patients undergoing major abdominal surgery have a high morbidity and mortality.
authors.affiliation: Department of Anaesthesaia, Christchurch Hospital.
authors.forename: A
authors.initials: A
authors.lastname: Audeau
authors.forename: P
authors.initials: P
authors.lastname: Newell
authors.forename: B R
authors.initials: BR
authors.lastname: Dobbs
authors.forename: F A
authors.initials: FA
authors.lastname: Frizelle
authors.forename: R
authors.initials: R
authors.lastname: Kennedy
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects* / Q000401:mortality*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology*; D011182:Postoperative Care / Q000009:adverse effects* / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment
chemical_list: D000701:Analgesics, Opioid