Could benefits of epidural analgesia following oesophagectomy be measured by perceived perioperative patient workload?
BACKGROUND
A controversy exists whether beneficial analgesic effects of epidural analgesia over intravenous analgesia influence the rate of post-operative complications and the length of hospital stay. There is some evidence that favours epidural analgesia following major surgery in high-risk patients. However, there is a controversy as to whether epidural analgesia reduces the intensive care resources following major surgery. In this study, we aimed at comparing the post-operative costs of intensive care in patients receiving epidural or intravenous analgesia.


METHODS
Clinical data and rates of post-operative complications were extracted from a previously reported trial following thoraco-abdominal oesophagectomy. Cost data for individual patients included in that trial were retrospectively obtained from administrative records. Two separate phases were defined: costs of pain treatment and the direct cost of intensive care.


RESULTS
Higher calculated costs of epidural vs. intravenous pain treatment, 1,037 vs. 410 Euros / patient, were outweighed by lower post-operative costs of intensive care 5,571 vs. 7,921 Euros / patient (NS).


CONCLUSIONS
Higher costs and better analgesic effects of epidural analgesia compared with intravenous analgesia do not reduce total costs for post-operative care following major surgery.
Bartha
E
E
Department of Anaesthesiology and Intensive Care, Karolinska University Hospital, Huddinge, Sweden. erzsebet.bartha@karolinska.se
Rudin
A
A
Flisberg
P
P
Lundberg
C J
CJ
Carlsson
P
P
Kalman
S
S
D015360:Analgesia, Epidural / Q000191:economics*; D016058:Analgesia, Patient-Controlled / Q000191:economics / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics*; D016629:Esophagectomy / Q000191:economics*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D019990:Perioperative Care; D011183:Postoperative Complications; D012189:Retrospective Studies; D016526:Workload
D000701:Analgesics, Opioid; D009020:Morphine