title: Association of no epidural analgesia with postoperative morbidity and mortality after transthoracic esophageal cancer resection.
abstract: BACKGROUND
  The aim of this study was to compare morbidity and mortality of patients who had epidural analgesia for at least 2 days after transthoracic esophagectomy for cancer with those who did not have epidural analgesia at all or who had it for less than 2 days.
  
  
  METHODS
  We analyzed 182 patients, 7 of whom were excluded. Patients were divided into two groups; 90 patients (51%) with epidural analgesia for at least 2 days (epidural group) and 85 patients (49%) who did not have epidural analgesia or had it for less than 2 days (no epidural group). To identify prognostic factors for pneumonia, univariate and multivariate logistic regression analyses were performed.
  
  
  RESULTS
  There were no notable differences in clinicopathologic characteristics or intraoperative measurements. In favor of the epidural group, marked differences were found in pneumonia (28% versus 48%, p = 0.005), reintubation (17% versus 34%, p = 0.011), ICU-stay (median 2.8 versus 5.8 days, p = 0.001), hospital stay (median 17 versus 21 days, p = 0.015), and in-hospital mortality (0 versus 8 patients, p = 0.003). No epidural analgesia (odds ratio [OR] 2.48, 95% CI 1.30 to 4.71, p = 0.006) and atelectasis (OR 2.06, 95% CI 1.08 to 3.90, p = 0.028) were independent predictors for pneumonia. There were eight in-hospital deaths.
  
  
  CONCLUSIONS
  No epidural analgesia for more than 2 days after a transthoracic esophageal cancer resection is associated with increased postoperative morbidity. To optimize postoperative recovery, it is of vital importance to ensure adequate epidural analgesia in these patients.
authors.affiliation: Department of Surgery, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Huibert A
authors.initials: HA
authors.lastname: Cense
authors.forename: Sjoerd M
authors.initials: SM
authors.lastname: Lagarde
authors.forename: Koen
authors.initials: K
authors.lastname: de Jong
authors.forename: Jikke M T
authors.initials: JM
authors.lastname: Omloo
authors.forename: Olivier R C
authors.initials: OR
authors.lastname: Busch
authors.forename: Ch Pieter
authors.initials: ChP
authors.lastname: Henny
authors.forename: J Jan B
authors.initials: JJ
authors.lastname: van Lanschot
mesh_terms: D015360:Analgesia, Epidural; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology* / Q000209:etiology; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013908:Thoracotomy / Q000009:adverse effects / Q000401:mortality*