title: Thromboprophylaxis and major oncologic surgery performed with epidural analgesia.
abstract: OBJECTIVE
  To evaluate clinical outcomes in patients with cancer undergoing major abdominal surgery who received preoperative indwelling epidural catheters (ECs) and no postoperative thromboprophylaxis.
  
  
  METHODS
  Retrospective analysis of a prospective database.
  
  
  METHODS
  Tertiary referral medical center. PATIENTS Between January 1, 2009, and July 31, 2011, 119 patients, with a mean age of 64.5 years (range, 34-95 years), underwent major abdominal oncologic surgery with an indwelling EC.
  
  
  METHODS
  Records of all patients were reviewed for age, duration of surgery, hospital length of stay, and clinical outcomes. All patients underwent lower extremity venous duplex ultrasonography prior to hospital discharge.
  
  
  RESULTS
  The average operative time was 338 minutes. Mean (SD) intensive care unit stay was 2.8 (1.4) days (range, 1-7 days). Patients ambulated by postoperative day 1 or 2. Most ECs were removed on postoperative day 4. There were no major complications from the EC. Fifty-two patients (44%) were treated with deep venous thrombosis prophylaxis on postoperative day 4 after removal of the EC. Lower extremity duplex studies showed 8 patients (6.7%) had an acute thrombus. One patient (0.8%) developed an asymptomatic proximal deep venous thrombosis and 7 patients (5.9%) developed distal superficial thrombi. No patient developed a pulmonary embolus. CONCLUSIONS Thromboembolic complications following major abdominal surgery for cancer may be reduced with the use of ECs. Epidural catheters may directly prevent deep venous thrombosis through sympathetic blockade, resulting in increased blood flow to the lower extremities. This effect may also be attributable to earlier ambulation. These results suggest that patients who have an EC and do not receive concurrent postoperative thromboprophylaxis do not have an increased risk for thromboembolic events.
authors.affiliation: Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Shouhed
authors.forename: Farin
authors.initials: F
authors.lastname: Amersi
authors.forename: Thomas
authors.initials: T
authors.lastname: Sibert
authors.forename: Karen
authors.initials: K
authors.lastname: Sibert
authors.forename: Emad
authors.initials: E
authors.lastname: Hemaya
authors.forename: Allan W
authors.initials: AW
authors.lastname: Silberman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural; D002408:Catheters, Indwelling; D004067:Digestive System Neoplasms / Q000601:surgery*; D004434:Early Ambulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013927:Thrombosis / Q000517:prevention & control*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000517:prevention & control