title: A nationwide analysis of the use and outcomes of epidural analgesia in open colorectal surgery.
abstract: BACKGROUND
  Epidural analgesia has demonstrated superiority over conventional analgesia in controlling pain following open colorectal resections. Controversy exists regarding cost-effectiveness and postoperative outcomes.
  
  
  METHODS
  The Nationwide Inpatient Sample (2002-2010) was retrospectively reviewed for elective open colorectal surgeries performed for benign and malignant conditions with or without the use of epidural analgesia. Multivariate regression analysis was used to compare outcomes between epidural and conventional analgesia.
  
  
  RESULTS
  A total 888,135 patients underwent open colorectal resections. Epidural analgesia was only used in 39,345 (4.4 %) cases. Epidurals were more likely to be used in teaching hospitals and rectal cancer cases. On multivariate analysis, in colonic cases, epidural analgesia lowered hospital charges by US$4,450 (p < 0.001) but was associated with longer length of stay by 0.16 day (p < 0.05) and a higher incidence of ileus (OR = 1.17; p < 0.01). In rectal cases, epidural analgesia was again associated with lower hospital charges by US$4,340 (p < 0.001) but had no effect on ileus and length of stay. The remaining outcomes such as mortality, respiratory failure, pneumonia, anastomotic leak, urinary tract infection, and retention were unaffected by the use of epidurals.
  
  
  CONCLUSIONS
  Epidural analgesia in open colorectal surgery is safe but does not add major clinical benefits over conventional analgesia. It appears however to lower hospital charges.
authors.affiliation: Department of Surgery, University of California, Irvine School of Medicine, Orange, CA, USA.
authors.forename: Wissam J
authors.initials: WJ
authors.lastname: Halabi
authors.forename: Mehraneh D
authors.initials: MD
authors.lastname: Jafari
authors.forename: Vinh Q
authors.initials: VQ
authors.lastname: Nguyen
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Carmichael
authors.forename: Steven
authors.initials: S
authors.lastname: Mills
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stamos
authors.forename: Alessio
authors.initials: A
authors.lastname: Pigazzi
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000191:economics* / Q000706:statistics & numerical data*; D003108:Colonic Diseases / Q000601:surgery*; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data; D006784:Hospitals, Teaching; D006801:Humans; D045823:Ileus / Q000209:etiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000601:surgery*; D012189:Retrospective Studies; D014481:United States