title: [Postoperative Management and Cost-effectiveness of Epidural Anesthesia in Patients undergoing Abdominal Aortic Replacement Surgery].
abstract: BACKGROUND
  The use of epidural anesthesia for ablominal aortic replacement surgery may be problematic because of the amount of heparin used during the procedure, which places the patient at increased risk of epidural hematoma. We evaluated its benefits, risks, postoperative outcomes and costs.
  
  
  METHODS
  We retrospectively collected data on 93 patients who underwent Y-graft infra-renal abdominal aortic replacement at our institution between 2008 and 2010. All patients were admitted to the intensive care unit (ICU) for postoperative care. We compared the mortality rate, the time until extubation, length of ICU and postoperative hospital stay, and ICU cost of those who received epidural anesthesia comparing with those who did not.
  
  
  RESULTS
  Thirty-two of the 93 patients (34.4%) received epidural anesthesia, which was used for 2-5 (mean ± SD ; 3.2 ± 0.8) postoperative days. Postoperative mortality during the 2-year period was 3.3% in the group that did not receive epidural anesthesia (two patients) compared with 3.1% (one patient) in the epidural group (P = 1.00). Postoperative respiratory disorders were recorded in 1.6% of patients who did not receive an epidural (one patient) compared with 6.3% (two patients) in those that did (P = 0.27). There were no reports of epidural hemorrhage, hematoma or infection. Patients with epidurals were extubated earlier than those in the non-epidural group (mean ± standard deviation 5.5 ± 7.2 hours versus 11.6 ± 7.9 hours, respectively P < 0.001), but there were no significant differences between the two groups in terms of ICU cost or length of ICU and postoperative hospital stay.
  
  
  CONCLUSIONS
  Epidural anesthesia during abdominal aortic replacement facilitated more rapid extubation, but did not appear to influence other aspects of patient recovery or ICU costs.
authors.forename: Naomi
authors.initials: N
authors.lastname: Ono
authors.forename: Junko
authors.initials: J
authors.lastname: Nakahira
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Sawai
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Minami
mesh_terms: D000005:Abdomen / Q000098:blood supply* / Q000601:surgery; D000368:Aged; D000767:Anesthesia, Epidural / Q000191:economics*; D001011:Aorta / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D011182:Postoperative Care / Q000191:economics*; D011184:Postoperative Period; D012189:Retrospective Studies