A nationwide analysis of the use and outcomes of perioperative epidural analgesia in patients undergoing hepatic and pancreatic surgery

• EA has been used to manage peri- and postoperative pain among patients undergoing major abdominal surgery over the last several decades; however, its use for hepatopancreatic procedures remains low, with fewer than 1 in 10 patients receiving EA.
• EA use among minimally invasive surgery has increased over the time periods examined (2000 to 2012).
• EA was associated with a slight prolongation of hospital stay; however, the increase is probably of marginal clinical significance.
• After controlling for several confounding factors using propensity matching, EA remained associated with a reduction in certain specific pulmonary-related complications, as well as overall in-hospital mortality.

BackgroundWe 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.MethodsThe 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.ResultsEA 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).ConclusionsEA 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.