The Southwestern Surgical CongressEffect of epidural analgesia on postoperative complications following pancreaticoduodenectomy
Section snippets
Study design
This retrospective cohort study used nationally representative inpatient discharge records from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) for 2009.13 Sponsored by the Agency for Healthcare Research and Quality, the Healthcare Cost and Utilization Project represents the largest national database in the United States of inpatient-level hospital-care cases, generalizing to >40 million discharges per year. The NIS includes clinical information on episodes of
Results
Overall, 8,610 cases of pancreaticoduodenectomy occurred within the United States in 2009, summing to a national bill of $1.3 billion. The average age across all cases was 63.3 ± .4 years, and 53.9% were men. The average length of stay was 15.4 ± .5 days, and mean charges were $149,353 ± $10,006. Most admissions were elective (77.5%). The mean Deyo-modified Charlson comorbidity index was 4.1 ± .1. The majority race was white (74.3%), followed by Hispanic (10.0%), black (7.4%), Asian (4.4%), and
Comments
The most important finding of this study was that epidural use in patients undergoing pancreaticoduodenectomy was associated with lower risk for composite complications, including death. Epidural analgesia use also resulted in shorter lengths of hospital stay and lower total charges. Our regression models adjusted for relevant confounders that included patient demographics, comorbidities. and hospital characteristics. The finding that epidural analgesia significantly decreases postoperative
Conclusions
Epidural analgesia use in patients undergoing Whipple procedures was associated with decreased postoperative complications, length of hospital stay, and hospital costs. These findings need to be confirmed in a large randomized controlled study. In the interim, unless contraindicated, epidural analgesia should be routinely used for pain control in these patients.
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Cited by (36)
Narcotic sparing postoperative analgesic strategies after pancreatoduodenectomy: analysis of practice patterns for 1004 patients
2022, HPBCitation Excerpt :One study found that EPI use was associated with lower pain scores, but increased rates of major surgical complications, attributed to rapid fluid shifts causing hemodynamic instability.20 In contrast another study reported decreased postoperative complications, length of stay and hospital costs in patients who received EPI compared to conventional analgesia.25 Another institutional study reported decreased rates of infectious and pulmonary complications as well as superior analgesia with EPI compared to non-EPI modalities.26
Epidural Versus Transabdominal Wall Catheters: A Comparative Study of Outcomes After Pancreatic Resection
2021, Journal of Surgical ResearchUse of perioperative epidural analgesia among Medicare patients undergoing hepatic and pancreatic surgery
2019, HPBCitation Excerpt :Data in the literature regarding the influence of EA use on the costs of the surgical episode are largely lacking. Amini et al. compared hospital charges - rather than costs incurred by payers - among patients who underwent a Whipple procedure who received EA versus conventional analgesia and reported that hospital charges were lower when EA was utilized.37 In the present study, despite the slightly longer LOS observed for patients who received EA (8 days vs. 7 days), when risk-adjusted Medicare payments were analyzed, EA was associated with increased expenditures only among patients undergoing an open pancreatic resection, with the difference in median Medicare payments for EA versus conventional analgesia totaling $1600 (p = 0.013) (Table 5).
Post-Pancreaticoduodenectomy Outcomes and Epidural Analgesia: A 5-year Single-Institution Experience
2019, Journal of the American College of SurgeonsCitation Excerpt :However, there was no significant difference in the rate of any individual component included in this aggregate analysis, including sepsis or wound infection.38 Another study examining PD alone revealed a higher rate of overall wound complications with the use of EDA, defined as internal or external disruption; it is unclear whether this definition includes wound infections, making comparison with the current study results difficult.42 Mechanistically, there is support in the literature for a reduced rate of infectious complications with the use of EDA through dampening of the stress response to the operation and its associated attenuation of the immune system.14,23,24
What Is the Best Pain Control After Major Hepatopancreatobiliary Surgery?
2018, Advances in Surgery