Effect of epidural analgesia on postoperative complications following pancreaticoduodenectomy

• Published in: The American journal of surgery Vol. 204; no. 6; pp. 1000 - 1006
• Main Authors: Amini, Albert, M.D, Patanwala, Asad E., Pharm.D, Maegawa, Felipe B., M.D, Skrepnek, Grant H., Ph.D, Jie, Tun, M.D, Gruessner, Rainer W., M.D, Ong, Evan S., M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.2012; Elsevier; Elsevier Limited
• Subjects: Analgesia, Epidural - economics; Analgesia, Epidural - statistics & numerical data; Biological and medical sciences; Cohort Studies; Complications; Epidural analgesia; Female; General aspects; Hospital Charges - statistics & numerical data; Humans; Length of Stay - statistics & numerical data; Linear Models; Male; Medical sciences; Middle Aged; Mortality; Multivariate Analysis; Odds Ratio; Pain management; Pain, Postoperative - prevention & control; Pancreaticoduodenectomy; Pancreaticoduodenectomy - economics; Pancreaticoduodenectomy - mortality; Pancreaticoduodenectomy - statistics & numerical data; Postoperative Care - economics; Postoperative Care - methods; Postoperative Complications - economics; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Retrospective Studies; Stomach, duodenum, intestine, rectum, anus; Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Surgical outcomes; Treatment Outcome; United States; United States; Complications; Epidural analgesia; Pancreaticoduodenectomy; Postoperative; Duodenum; Digestive system; Small intestine; Extradural; Medicine; Regional anesthesia; Treatment; Surgery; Extradural administration; Complication; Pancreas; Pancreatoduodenectomy
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2012.05.022

Abstract Background The purpose of this study was to evaluate the effect of epidural analgesia use on postoperative complications in patients undergoing pancreaticoduodenectomy. Methods This retrospective cohort study used the 2009 Nationwide Inpatient Sample from the Agency for Healthcare Research and Quality. Patients who underwent pancreaticoduodenectomy were grouped on the basis of whether they received epidural analgesia. The effect of epidural use on the composite end point of major complications including death was investigated using a generalized linear model. Results Overall, 8,610 cases of pancreaticoduodenectomy occurred within the United States in 2009, and 11.0% of these patients received epidural analgesia. After controlling for various potential confounders, results of the multivariate regression indicated that epidural analgesia use was associated with lower odds of composite complications including death (odds ratio, .61; 95% confidence interval, .37–.99; P = .044). Conclusions In patients who underwent pancreaticoduodenectomy, epidural analgesia was associated with significantly lower postoperative composite complications.