title: Impact of remifentanil use on early postoperative outcomes following brain tumor resection or rectal cancer surgery.
abstract: OBJECTIVE
  Remifentanil, a mu-opioid receptor agonist, has important characteristics for neuroanesthesia, but data about its effects on postoperative recovery and mortality are currently lacking.
  
  
  METHODS
  Using the Japanese Diagnosis Procedure Combination database in 2007, we selected patients who underwent elective brain tumor resection with open craniotomy under general anesthesia using either remifentanil or fentanyl and divided them into two categories: remifentanil patients and non-remifentanil patients. After propensity score matching for potential confounders, we compared the in-hospital mortality and postoperative length of stay (LOS) between the two groups. For comparison, the same endpoints were evaluated for patients underwent rectal cancer surgery under general anesthesia with intraoperative epidural anesthesia.
  
  
  RESULTS
  In patients who underwent brain tumor resection (936 pairs), remifentanil patients had significantly lower in-hospital mortality (1.5 % vs. 3.0 %; P = 0.029). Logistic regression analysis revealed that the odds ratio for use of remifentanil for in-hospital mortality was 0.47 (95 % confidence interval, 0.25-0.91; P = 0.025). Remifentanil patients also showed earlier discharge from hospital (median LOS, 17 vs. 19 days; hazard ratio, 1.19, 95 % confidence interval, 1.08-1.30; P < 0.001). In contrast, in 2,756 pairs of patients undergoing rectal cancer surgery, no significant difference was seen in either in-hospital morality (1.2 % vs. 1.3 %; P = 0.518) or median LOS (19 vs. 19 days; P = 0.148) between the two groups.
  
  
  CONCLUSIONS
  Our data suggest a possible association between use of remifentanil and better early postoperative recovery for patients undergoing neurosurgery with craniotomy. Further studies, including a randomized controlled trial, are required to confirm the present results.
authors.affiliation: Department of Anesthesiology, Tokyo University Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. uchidak-ane@h.u-tokyo.ac.jp
authors.forename: Kanji
authors.initials: K
authors.lastname: Uchida
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Miyata
authors.forename: Masahiko
authors.initials: M
authors.lastname: Sumitani
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuda
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Yamada
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000762:Anesthesia Recovery Period; D000767:Anesthesia, Epidural / Q000379:methods; D000768:Anesthesia, General / Q000379:methods*; D001932:Brain Neoplasms / Q000601:surgery*; D003399:Craniotomy / Q000379:methods; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D010880:Piperidines / Q000008:administration & dosage*; D011184:Postoperative Period; D017450:Receptors, Opioid, mu / Q000819:agonists; D012004:Rectal Neoplasms / Q000601:surgery*; D000077208:Remifentanil; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D010880:Piperidines; D017450:Receptors, Opioid, mu; D000077208:Remifentanil; D005283:Fentanyl