title: Association of thoracic epidural analgesia with risk of atrial arrhythmias after pulmonary resection: a retrospective cohort study.
abstract: OBJECTIVE
  Atrial arrhythmias are common after non-cardiac thoracic surgery. We tested the hypothesis that TEA reduces the risk of new-onset atrial arrhythmias after pulmonary resection.
  
  
  METHODS
  We evaluated patients who had pulmonary resection. New-onset atrial arrhythmias detected before hospital discharge was our primary outcome. Secondary outcomes included other cardiovascular complications, pulmonary complications, time-weighted average pain score over 72 h, and duration of hospitalization. Patients with combination of general anesthesia and TEA were matched on propensity scores with patients given general anesthesia only. The matched groups were compared by use of logistic regression, linear regression, or Cox proportional hazards regression, as appropriate.
  
  
  RESULTS
  Among 1,236 patients who had pulmonary resections, 937 received a combination of general anesthesia and TEA (TEA) and 299 received general anesthesia only (non-TEA). We successfully matched 311 TEA patients with 132 non-TEA patients. We did not find a significant association between TEA and postoperative atrial arrhythmia (odds ratio (95 % CI) of 1.05 (0.50, 2.19), P = 0.9). TEA was not significantly associated with length of hospital stay or postoperative pulmonary complications (odds ratio (95 % CI) of 0.71 (0.22, 2.29), P = 0.47). TEA patients experienced fewer postoperative cardiovascular complications; although the association was not statistically significant (odds ratio (95 % CI) of 0.30 (0.06, 1.45), P = 0.06). Time-weighted average pain scores were similar in the two groups.
  
  
  CONCLUSIONS
  TEA was not associated with reduced occurrence of postoperative atrial arrhythmia. Although postoperative pulmonary complications were similar with and without TEA, TEA patients tended to experience fewer cardiovascular complications.
authors: Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue/E30, Cleveland, OH, 44195, USA, ryukomatsu80@gmail.com.
authors: Ryu
authors: R
authors: Komatsu
authors: Natalya
authors: N
authors: Makarova
authors: Jarrod E
authors: JE
authors: Dalton
authors: Zhuo
authors: Z
authors: Sun
authors: Dennis
authors: D
authors: Chang
authors: Radhika
authors: R
authors: Grandhe
authors: Roshni
authors: R
authors: Sreedharan
authors: Karine
authors: K
authors: De Oliveira Dias
authors: Rakhi
authors: R
authors: Pal
authors: Allen
authors: A
authors: Bashour
authors: Sudish C
authors: SC
authors: Murthy
authors: Alparslan
authors: A
authors: Turan
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods; D001145:Arrhythmias, Cardiac / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010149:Postoperative Pain / Q000188:drug therapy; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011184:Postoperative Period; D013510:Pulmonary Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D012306:Risk