title: Epidural analgesia is associated with improved health outcomes of surgical patients with chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Patients with chronic obstructive pulmonary disease (COPD) have increased postoperative morbidity and mortality. Epidural analgesia (EDA) improves postoperative outcome but may worsen postoperative lung function. It is unknown whether patients with COPD benefit from EDA. The objective of this study was to determine whether patients with COPD undergoing major abdominal surgery benefit from EDA in addition to general anesthesia.
  
  
  METHODS
  This cohort study included 541 consecutive patients with COPD who underwent major abdominal surgery between 1995 and 2007 at a university medical center. Propensity scores estimating the probability of receiving EDA were used in multivariate correction. The primary outcome was postoperative pneumonia and 30-day mortality.
  
  
  RESULTS
  There were 324 patients (60%) who received EDA in addition to general anesthesia. The incidence of postoperative pneumonia (16% vs. 11%; P = 0.08) and 30-day mortality (9% vs. 5%; P = 0.03) was lower in patients who received EDA. After correction EDA was associated with improved outcome for postoperative pneumonia (OR 0.5; 95% CI: 0.3-0.9; P = 0.03). The strongest preventive effect was seen in patients with the most severe type of COPD.
  
  
  CONCLUSIONS
  This study provides evidence that in patients with COPD who are scheduled for major abdominal surgery, epidural analgesia decreases postoperative pulmonary complications.
authors.affiliation: Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Felix
authors.initials: F
authors.lastname: van Lier
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: van der Geest
authors.forename: Sanne E
authors.initials: SE
authors.lastname: Hoeks
authors.forename: Yvette R B M
authors.initials: YR
authors.lastname: van Gestel
authors.forename: Jaap W
authors.initials: JW
authors.lastname: Hol
authors.forename: Don D
authors.initials: DD
authors.lastname: Sin
authors.forename: Robert Jan
authors.initials: RJ
authors.lastname: Stolker
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000005:Abdomen / Q000601:surgery; D000368:Aged; D015360:Analgesia, Epidural; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000401:mortality; D012189:Retrospective Studies