title: Tunnelling of thoracic epidural catheters is associated with fewer catheter-related infections: a retrospective registry analysis.
abstract: BACKGROUND
  Catheter-related infections are a serious complication of continuous thoracic epidural analgesia. Tunnelling catheters subcutaneously may reduce infection risk. We thus tested the hypothesis that tunnelling of thoracic epidural catheters is associated with a lower risk of catheter-related infections.
  
  
  METHODS
  Twenty-two thousand, four hundred and eleven surgical patients with continuous thoracic epidural analgesia included in the German Network for Regional Anaesthesia registry between 2007 and 2014 were grouped by whether their catheters were tunnelled (n=12 870) or not (n=9541). Catheter-related infections in each group were compared with Student's unpaired t and χ(2) tests. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with logistic regression, adjusting for potential confounding factors, including age, ASA physical status score, use of catheter for ≥4 days, multiple skin puncture, hospital, and surgical department.
  
  
  RESULTS
  There were fewer catheter-related infections in patients with tunnelled catheters (4.5 vs 5.5%, P<0.001). Mild infections were also less common (4.0 vs 4.6%, P=0.009), as were moderate infections (0.4 vs 0.8%, P<0.001). After adjustment for potential confounding factors, tunnelling remained an independent prevention for any grade of infection (adjusted OR 0.51, 95% CI 0.42-0.61, P<0.001) and for mild infections (adjusted OR 0.54, 95% CI 0.43-0.66, P<0.001) and moderate and severe infections (adjusted OR 0.44, 95% CI 0.28-0.70, P=0.001).
  
  
  CONCLUSIONS
  Tunnelling was associated with a lower risk of thoracic epidural catheter-related infections.
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine.
authors.forename: H
authors.initials: H
authors.lastname: Bomberg
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine.
authors.forename: C
authors.initials: C
authors.lastname: Kubulus
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine.
authors.forename: S
authors.initials: S
authors.lastname: Herberger
authors.affiliation: Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, University Medical Centre, Homburg/Saar, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Wagenpfeil
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, Orthopaedic University Hospital, Frankfurt, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Kessler
authors.affiliation: Department of Anaesthesiology and Intensive Care Therapy, Philipps University Marburg, Marburg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Steinfeldt
authors.affiliation: Department of Anaesthesia, Intensive and Palliative Care Medicine, Academic Hospital Solingen, Solingen, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Standl
authors.affiliation: Department of Anaesthesiology, Intensive Care and Pain Medicine, Friederikenstift Hannover, Hannover, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Gottschalk
authors.affiliation: Centre for Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, Hamburg D-20246, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Stork
authors.affiliation: Department of Anaesthesiology and Intensive Care, Jena University Hospital, Jena, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Meissner
authors.affiliation: Department of Anaesthesiology and Operative Intensive Care Medicine, Charité Campus Virchow Klinikum and Campus Mitte, Charité University Medicine Berlin, Berlin, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Birnbaum
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Koch
authors.affiliation: Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Avenue P77, Cleveland, OH 44195, USA.
authors.forename: D I
authors.initials: DI
authors.lastname: Sessler
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine.
authors.forename: T
authors.initials: T
authors.lastname: Volk
authors.affiliation: Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine.
authors.forename: A
authors.initials: A
authors.lastname: Raddatz
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control; D002404:Catheterization / Q000379:methods*; D057785:Catheters; D016208:Databases, Factual; D004824:Epidural Space; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology / Q000209:etiology; D017060:Patient Satisfaction; D012042:Registries; D012189:Retrospective Studies; D013904:Thoracic Vertebrae
keywords: anaesthesia, regional; analgesia, epidural; infection