Improved peri-operative outcomes with epidural analgesia in patients undergoing a pancreatectomy: a nationwide analysis.
BACKGROUND
In spite of limited evidence demonstrating a benefit, epidural analgesia (EA) is often used for patients undergoing a pancreatectomy. In the present study, the impact of epidural analgesia on post-operative outcomes after a pancreatectomy is examined.


METHODS
Utilizing the Nationwide Inpatient Sample, the effect of EA on peri-operative outcomes after a pancreatectomy was examined. Multivariable logistic and linear regression with propensity score matching were utilized for risk adjustment.


RESULTS
From 2008-2011, 12,440 patients underwent a pancreatectomy. Of these, 1130 (9.1%) patients received epidural analgesia. Using univariate comparison, patients receiving EA had a significantly decreased length of stay (LOS), hospital charges and post-operative inpatient mortality. In multivariate analyses, EA was independently associated with a decreased post-operative LOS (adjusted mean difference = -1.19 days, P < 0.001), decreased hospital charges (adjusted mean difference = -$16,814, P = 0.002) and decreased post-operative inpatient mortality [adjusted odds ratio (OR) = 0.42, P < 0.001]. Using 1:1 propensity score matching, patients who received an EA (n = 1070) had significantly decreased post-operative LOS (11.0 versus 12.1 days, P = 0.011), lower hospital charges ($112,086 versus $128,939, P = 0.001) and decreased post-operative inpatient mortality (1.5% versus 3.6%, P = 0.002) compared with matched controls without EA (n = 1070).


CONCLUSIONS
Analysis of a large hospital database reveals that EA is associated with improved peri-operative outcomes after a pancreatectomy. Additional studies are required to understand fully if this relationship is causal.
Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO, USA.
Dominic E
DE
Sanford
Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO, USA.|Alvin J. Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA.
William G
WG
Hawkins
Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO, USA.|Alvin J. Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA.
Ryan C
RC
Fields
D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D016009:Chi-Square Distribution; D017046:Cost Savings; D016208:Databases, Factual; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010180:Pancreatectomy / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D011183:Postoperative Complications / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000517:prevention & control*; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States