title: A nationwide analysis of the use and outcomes of perioperative epidural analgesia in patients undergoing hepatic and pancreatic surgery.
abstract: BACKGROUND
  We sought to define trends in the use of epidural analgesia (EA) for hepatopancreatic procedures, as well as to characterize inpatient outcomes relative to the use of EA.
  
  
  METHODS
  The Nationwide Inpatient Sample database was queried to identify all elective hepatopancreatic surgeries between 2000 and 2012. In-hospital outcomes were compared among patients receiving EA vs conventional analgesia using propensity matching.
  
  
  RESULTS
  EA utilization was 7.4% (n = 3,961). The use of EA among minimally invasive procedures increased from 3.8% in 2000 to 9.1% in 2012. The odds of sepsis (odds ratio [OR] .72, 95% confidence interval [CI] .56 to .93), respiratory failure (OR .79, 95% CI .69 to .91), and postoperative pneumonia (OR .77, 95% CI .61 to .98), as well as overall in-hospital mortality (OR .72, 95% CI .56 to .93) were lower in the EA cohort (all P < .05). In contrast, no association was noted between EA and postoperative hemorrhage (OR .81, 95% CI .65 to 1.01, P = .06).
  
  
  CONCLUSIONS
  EA use among patients undergoing hepatopancreatic procedures remains low. After controlling for confounding factors, EA remained associated with a reduction in specific pulmonary-related complications, as well as in-hospital mortality.
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 688, Baltimore, MD 21287, USA.
authors.forename: Neda
authors.initials: N
authors.lastname: Amini
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 688, Baltimore, MD 21287, USA.
authors.forename: Yuhree
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Management, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Hyder
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 688, Baltimore, MD 21287, USA.
authors.forename: Gaya
authors.initials: G
authors.lastname: Spolverato
authors.affiliation: Department of Anesthesia and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wu
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 688, Baltimore, MD 21287, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Page
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 688, Baltimore, MD 21287, USA. Electronic address: tpawlik1@jhmi.edu.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural / Q000706:statistics & numerical data*; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008099:Liver / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control; D010179:Pancreas / Q000601:surgery*; D011014:Pneumonia / Q000453:epidemiology; D011183:Postoperative Complications; D057216:Propensity Score; D012131:Respiratory Insufficiency / Q000453:epidemiology; D018805:Sepsis / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
keywords: Epidural analgesia; Liver resection; Outcome; Pancreatic resection