title: Epidural anesthesia improves outcome and resource use in cardiac surgery: a single-center study of a 1293-patient cohort.
abstract: Thoracic epidural anesthesia (TEA) combined with general anesthesia in cardiac surgery has the potential to initiate earlier spontaneous ventilation and extubation, improved hemodynamics, less arrhythmia or myocardial ischemia, and an attenuated neurohormonal response. The aim of the current study was to characterize the correlation between TEA and postoperative resource use or outcome in a consecutive-patient cohort. The study was performed in a tertiary care, 3-surgeon, university-affiliated hospital that performs 350 to 400 cardiac surgeries per year. All 1293 adult patients who underwent cardiac surgery between July 1, 2002, and February 1, 2006, were included. Patients were assigned to anesthesiologists practicing TEA (TEA group, n = 506) or not (control group, n = 787) for cardiac surgery. The preoperative parameter values and Parsonnet scores for the 2 groups were similar. The 2 groups had the same distribution of surgery types. The TEA group presented with fewer intensive care unit (ICU) complications, such as delirium, pneumonia, and acute renal failure, and presented with better myocardial protection. The TEA group presented with a higher proportion of immediately postoperative extubations and with shorter ventilation times and ICU stays. Total ICU costs decreased from US $18,700 to $9900 per patient. Combining TEA and general anesthesia for cardiac surgery allows a significant change in anesthesia strategy. This change improves immediate postoperative outcomes and reduces the use and costs of ICU resources.
authors.affiliation: Department of Anesthesiology, Hôtel-Dieu Hospital, Université de Montréal Hospital, Montréal, Québec, Canada. David.Bracco@McGill.Ca
authors.forename: David
authors.initials: D
authors.lastname: Bracco
authors.forename: Nicolas
authors.initials: N
authors.lastname: Noiseux
authors.forename: Marc-Jacques
authors.initials: MJ
authors.lastname: Dubois
authors.forename: Ignacio
authors.initials: I
authors.lastname: Prieto
authors.forename: Fadi
authors.initials: F
authors.lastname: Basile
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Olivier
authors.forename: Thomas
authors.initials: T
authors.lastname: Hemmerling
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome