title: Is It Time to Reconsider Postoperative Epidural Analgesia in Patients Undergoing Elective Ventral Hernia Repair?: An AHSQC Analysis.
abstract: We aimed to evaluate the association of epidural analgesia (EA) with hospital length of stay (LOS), wound morbidity, postoperative complications, and patient-reported outcomes in patients undergoing ventral hernia repair (VHR).
  
  
  
  EA has been shown to reduce LOS in certain surgical populations. The LOS benefit in VHR is unclear.
  
  
  
  Patients having VHR performed in the Americas Hernia Society Quality Collaborative (AHSQC) were separated into 2 comparable groups matched on several confounding factors using a propensity score algorithm: one group received postoperative EA, and the other did not. The groups were then evaluated for hospital LOS, 30-day wound morbidity, other complications, and 30-day patient-reported outcomes using pain and hernia-specific quality-of-life instruments.
  
  
  
  A 1:1 match was achieved and the final analysis included 763 patients receiving EA and 763 not receiving EA. The EA group had an increased LOS (5.49 vs 4.90 days; P < 0.05). The rate of wound events was similar between the groups. There was an increased risk of having any postoperative complication associated with having EA (26% vs 21%; P < 0.05). Pain intensity-scaled scores were significantly higher (worse) in the EA group versus the non-EA group (47.6 vs 44.0; P = 0.04).
  
  
  
  The LOS benefit of EA noted for other operations may not apply to patients undergoing VHR. Further study is necessary to determine the beneficial role of invasive pain management procedures in this group of patients with an extremely common disease state.
authors.affiliation: Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Ajita S
authors.initials: AS
authors.lastname: Prabhu
authors.affiliation: Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: David M
authors.initials: DM
authors.lastname: Krpata
authors.affiliation: Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Arielle
authors.initials: A
authors.lastname: Perez
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Sharon
authors.initials: S
authors.lastname: Phillips
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Li-Ching
authors.initials: LC
authors.lastname: Huang
authors.affiliation: Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Ivy N
authors.initials: IN
authors.lastname: Haskins
authors.affiliation: Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Steven
authors.initials: S
authors.lastname: Rosenblatt
authors.affiliation: The Vanderbilt Hernia Center, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Benjamin K
authors.initials: BK
authors.lastname: Poulose
authors.affiliation: Comprehensive Hernia Center, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rosen
mesh_terms: D015360:Analgesia, Epidural / Q000379:methods*; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D010149:Postoperative Pain / Q000453:epidemiology / Q000628:therapy*; D000071066:Patient Reported Outcome Measures; D011182:Postoperative Care / Q000379:methods*; D057216:Propensity Score; D012189:Retrospective Studies; D012955:Societies, Medical; D013997:Time Factors; D014481:United States / Q000453:epidemiology