A Nationwide Analysis of the Use and Outcomes of Epidural Analgesia in Open Colorectal Surgery

Wissam J Halabi, Mehraneh D. Jafari, Vinh Q. Nguyen, Joseph C. Carmichael, Steven Mills, Michael J. Stamos, Alessio Pigazzi

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Introduction: Epidural analgesia has demonstrated superiority over conventional analgesia in controlling pain following open colorectal resections. Controversy exists regarding cost-effectiveness and postoperative outcomes. Methods: The Nationwide Inpatient Sample (2002-2010) was retrospectively reviewed for elective open colorectal surgeries performed for benign and malignant conditions with or without the use of epidural analgesia. Multivariate regression analysis was used to compare outcomes between epidural and conventional analgesia. Results: A total 888,135 patients underwent open colorectal resections. Epidural analgesia was only used in 39,345 (4.4 %) cases. Epidurals were more likely to be used in teaching hospitals and rectal cancer cases. On multivariate analysis, in colonic cases, epidural analgesia lowered hospital charges by US$4,450 (p < 0.001) but was associated with longer length of stay by 0.16 day (p < 0.05) and a higher incidence of ileus (OR = 1.17; p < 0.01). In rectal cases, epidural analgesia was again associated with lower hospital charges by US$4,340 (p < 0.001) but had no effect on ileus and length of stay. The remaining outcomes such as mortality, respiratory failure, pneumonia, anastomotic leak, urinary tract infection, and retention were unaffected by the use of epidurals. Conclusion: Epidural analgesia in open colorectal surgery is safe but does not add major clinical benefits over conventional analgesia. It appears however to lower hospital charges.

Original languageEnglish (US)
Pages (from-to)1130-1137
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume17
Issue number6
DOIs
StatePublished - Mar 1 2013
Externally publishedYes

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Colorectal Surgery
Epidural Analgesia
Hospital Charges
Ileus
Analgesia
Length of Stay
Multivariate Analysis
Anastomotic Leak
Urinary Retention
Rectal Neoplasms
Urinary Tract Infections
Teaching Hospitals
Respiratory Insufficiency
Cost-Benefit Analysis
Inpatients
Pneumonia
Regression Analysis
Pain
Mortality
Incidence

Keywords

  • Analgesia
  • Anastomotic leak
  • Charge
  • Colorectal
  • Epidural
  • Ileus
  • Length of stay
  • Nationwide Inpatient Sample
  • Open surgery
  • Outcomes research
  • Pneumonia
  • Respiratory failure
  • Urinary retention
  • Urinary tract infection

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

A Nationwide Analysis of the Use and Outcomes of Epidural Analgesia in Open Colorectal Surgery. / Halabi, Wissam J; Jafari, Mehraneh D.; Nguyen, Vinh Q.; Carmichael, Joseph C.; Mills, Steven; Stamos, Michael J.; Pigazzi, Alessio.

In: Journal of Gastrointestinal Surgery, Vol. 17, No. 6, 01.03.2013, p. 1130-1137.

Research output: Contribution to journalArticle

Halabi, Wissam J ; Jafari, Mehraneh D. ; Nguyen, Vinh Q. ; Carmichael, Joseph C. ; Mills, Steven ; Stamos, Michael J. ; Pigazzi, Alessio. / A Nationwide Analysis of the Use and Outcomes of Epidural Analgesia in Open Colorectal Surgery. In: Journal of Gastrointestinal Surgery. 2013 ; Vol. 17, No. 6. pp. 1130-1137.
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N2 - Introduction: Epidural analgesia has demonstrated superiority over conventional analgesia in controlling pain following open colorectal resections. Controversy exists regarding cost-effectiveness and postoperative outcomes. Methods: The Nationwide Inpatient Sample (2002-2010) was retrospectively reviewed for elective open colorectal surgeries performed for benign and malignant conditions with or without the use of epidural analgesia. Multivariate regression analysis was used to compare outcomes between epidural and conventional analgesia. Results: A total 888,135 patients underwent open colorectal resections. Epidural analgesia was only used in 39,345 (4.4 %) cases. Epidurals were more likely to be used in teaching hospitals and rectal cancer cases. On multivariate analysis, in colonic cases, epidural analgesia lowered hospital charges by US$4,450 (p < 0.001) but was associated with longer length of stay by 0.16 day (p < 0.05) and a higher incidence of ileus (OR = 1.17; p < 0.01). In rectal cases, epidural analgesia was again associated with lower hospital charges by US$4,340 (p < 0.001) but had no effect on ileus and length of stay. The remaining outcomes such as mortality, respiratory failure, pneumonia, anastomotic leak, urinary tract infection, and retention were unaffected by the use of epidurals. Conclusion: Epidural analgesia in open colorectal surgery is safe but does not add major clinical benefits over conventional analgesia. It appears however to lower hospital charges.

AB - Introduction: Epidural analgesia has demonstrated superiority over conventional analgesia in controlling pain following open colorectal resections. Controversy exists regarding cost-effectiveness and postoperative outcomes. Methods: The Nationwide Inpatient Sample (2002-2010) was retrospectively reviewed for elective open colorectal surgeries performed for benign and malignant conditions with or without the use of epidural analgesia. Multivariate regression analysis was used to compare outcomes between epidural and conventional analgesia. Results: A total 888,135 patients underwent open colorectal resections. Epidural analgesia was only used in 39,345 (4.4 %) cases. Epidurals were more likely to be used in teaching hospitals and rectal cancer cases. On multivariate analysis, in colonic cases, epidural analgesia lowered hospital charges by US$4,450 (p < 0.001) but was associated with longer length of stay by 0.16 day (p < 0.05) and a higher incidence of ileus (OR = 1.17; p < 0.01). In rectal cases, epidural analgesia was again associated with lower hospital charges by US$4,340 (p < 0.001) but had no effect on ileus and length of stay. The remaining outcomes such as mortality, respiratory failure, pneumonia, anastomotic leak, urinary tract infection, and retention were unaffected by the use of epidurals. Conclusion: Epidural analgesia in open colorectal surgery is safe but does not add major clinical benefits over conventional analgesia. It appears however to lower hospital charges.

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