Epidural analgesia in laparoscopic colorectal surgery: A Nationwide analysis of use and outcomes

Wissam J Halabi, Celeste Y. Kang, Vinh Q. Nguyen, Joseph C. Carmichael, Steven Mills, Michael J. Stamos, Alessio Pigazzi

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

IMPORTANCE: The use of epidural analgesia in laparoscopic colorectal surgery has demonstrated superiority over conventional analgesia in controlling pain. Controversy exists, however, regarding its cost-effectiveness and its effect on postoperative outcomes. OBJECTIVES: To examine the use of epidural analgesia in laparoscopic colorectal surgery at the national level and to compare its outcomes with those of conventional analgesia. DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective review of laparoscopic colorectal cases performed with or without epidural analgesia for cancer, diverticular disease, and benign polyps. Patient demographic characteristics, disease and procedure types, and hospital settings were listed for patients in the epidural and conventional analgesia groups. A 1 to 4 case-matched analysis was performed, matching for patient demographic characteristics, hospital setting, indications, and procedure type. Data were obtained from the Nationwide Inpatient Sample between January 1, 2002, and December 31, 2010. MAIN OUTCOMES AND MEASURES: Total hospital charge, length of stay, mortality, pneumonia, respiratory failure, urinary tract infection, urinary retention, anastomotic leak, and postoperative ileus. RESULTS: A total of 191 576 laparoscopic colorectal cases were identified during the study period. Epidural analgesia was used in 4102 cases (2.14%). Epidurals were more likely to be used in large teaching hospitals, cancer cases, and rectal operations. On case-matched analysis, epidural analgesia was associated with a longer hospital stay by 0.60 day (P = .003), higher hospital charges by $3732.71 (P = .02), and higher rate of urinary tract infection (odds ratio = 1.81; P = .05). Epidural analgesia did not affect the incidence of respiratory failure, pneumonia, anastomotic leak, ileus, or urinary retention. CONCLUSIONS AND RELEVANCE: The perioperative use of epidural analgesia in laparoscopic colorectal surgery is limited in the United States. While epidural analgesia appears to be safe, it comes with higher hospital charges, longer hospital stay, and a higher incidence of urinary tract infections.

Original languageEnglish (US)
Pages (from-to)130-136
Number of pages7
JournalJAMA Surgery
Volume149
Issue number2
DOIs
StatePublished - Feb 1 2014
Externally publishedYes

Fingerprint

Colorectal Surgery
Epidural Analgesia
Laparoscopy
Hospital Charges
Urinary Tract Infections
Length of Stay
Anastomotic Leak
Urinary Retention
Ileus
Respiratory Insufficiency
Analgesia
Pneumonia
Demography
Incidence
Rectal Neoplasms
Polyps
Teaching Hospitals
Cost-Benefit Analysis
Inpatients
Odds Ratio

ASJC Scopus subject areas

  • Surgery

Cite this

Halabi, W. J., Kang, C. Y., Nguyen, V. Q., Carmichael, J. C., Mills, S., Stamos, M. J., & Pigazzi, A. (2014). Epidural analgesia in laparoscopic colorectal surgery: A Nationwide analysis of use and outcomes. JAMA Surgery, 149(2), 130-136. https://doi.org/10.1001/jamasurg.2013.3186

Epidural analgesia in laparoscopic colorectal surgery : A Nationwide analysis of use and outcomes. / Halabi, Wissam J; Kang, Celeste Y.; Nguyen, Vinh Q.; Carmichael, Joseph C.; Mills, Steven; Stamos, Michael J.; Pigazzi, Alessio.

In: JAMA Surgery, Vol. 149, No. 2, 01.02.2014, p. 130-136.

Research output: Contribution to journalArticle

Halabi, WJ, Kang, CY, Nguyen, VQ, Carmichael, JC, Mills, S, Stamos, MJ & Pigazzi, A 2014, 'Epidural analgesia in laparoscopic colorectal surgery: A Nationwide analysis of use and outcomes', JAMA Surgery, vol. 149, no. 2, pp. 130-136. https://doi.org/10.1001/jamasurg.2013.3186
Halabi, Wissam J ; Kang, Celeste Y. ; Nguyen, Vinh Q. ; Carmichael, Joseph C. ; Mills, Steven ; Stamos, Michael J. ; Pigazzi, Alessio. / Epidural analgesia in laparoscopic colorectal surgery : A Nationwide analysis of use and outcomes. In: JAMA Surgery. 2014 ; Vol. 149, No. 2. pp. 130-136.
@article{b78ca6b3bd5a4a0da961c7cca47be128,
title = "Epidural analgesia in laparoscopic colorectal surgery: A Nationwide analysis of use and outcomes",
abstract = "IMPORTANCE: The use of epidural analgesia in laparoscopic colorectal surgery has demonstrated superiority over conventional analgesia in controlling pain. Controversy exists, however, regarding its cost-effectiveness and its effect on postoperative outcomes. OBJECTIVES: To examine the use of epidural analgesia in laparoscopic colorectal surgery at the national level and to compare its outcomes with those of conventional analgesia. DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective review of laparoscopic colorectal cases performed with or without epidural analgesia for cancer, diverticular disease, and benign polyps. Patient demographic characteristics, disease and procedure types, and hospital settings were listed for patients in the epidural and conventional analgesia groups. A 1 to 4 case-matched analysis was performed, matching for patient demographic characteristics, hospital setting, indications, and procedure type. Data were obtained from the Nationwide Inpatient Sample between January 1, 2002, and December 31, 2010. MAIN OUTCOMES AND MEASURES: Total hospital charge, length of stay, mortality, pneumonia, respiratory failure, urinary tract infection, urinary retention, anastomotic leak, and postoperative ileus. RESULTS: A total of 191 576 laparoscopic colorectal cases were identified during the study period. Epidural analgesia was used in 4102 cases (2.14{\%}). Epidurals were more likely to be used in large teaching hospitals, cancer cases, and rectal operations. On case-matched analysis, epidural analgesia was associated with a longer hospital stay by 0.60 day (P = .003), higher hospital charges by $3732.71 (P = .02), and higher rate of urinary tract infection (odds ratio = 1.81; P = .05). Epidural analgesia did not affect the incidence of respiratory failure, pneumonia, anastomotic leak, ileus, or urinary retention. CONCLUSIONS AND RELEVANCE: The perioperative use of epidural analgesia in laparoscopic colorectal surgery is limited in the United States. While epidural analgesia appears to be safe, it comes with higher hospital charges, longer hospital stay, and a higher incidence of urinary tract infections.",
author = "Halabi, {Wissam J} and Kang, {Celeste Y.} and Nguyen, {Vinh Q.} and Carmichael, {Joseph C.} and Steven Mills and Stamos, {Michael J.} and Alessio Pigazzi",
year = "2014",
month = "2",
day = "1",
doi = "10.1001/jamasurg.2013.3186",
language = "English (US)",
volume = "149",
pages = "130--136",
journal = "JAMA Surgery",
issn = "2168-6254",
publisher = "American Medical Association",
number = "2",

}

TY - JOUR

T1 - Epidural analgesia in laparoscopic colorectal surgery

T2 - A Nationwide analysis of use and outcomes

AU - Halabi, Wissam J

AU - Kang, Celeste Y.

AU - Nguyen, Vinh Q.

AU - Carmichael, Joseph C.

AU - Mills, Steven

AU - Stamos, Michael J.

AU - Pigazzi, Alessio

PY - 2014/2/1

Y1 - 2014/2/1

N2 - IMPORTANCE: The use of epidural analgesia in laparoscopic colorectal surgery has demonstrated superiority over conventional analgesia in controlling pain. Controversy exists, however, regarding its cost-effectiveness and its effect on postoperative outcomes. OBJECTIVES: To examine the use of epidural analgesia in laparoscopic colorectal surgery at the national level and to compare its outcomes with those of conventional analgesia. DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective review of laparoscopic colorectal cases performed with or without epidural analgesia for cancer, diverticular disease, and benign polyps. Patient demographic characteristics, disease and procedure types, and hospital settings were listed for patients in the epidural and conventional analgesia groups. A 1 to 4 case-matched analysis was performed, matching for patient demographic characteristics, hospital setting, indications, and procedure type. Data were obtained from the Nationwide Inpatient Sample between January 1, 2002, and December 31, 2010. MAIN OUTCOMES AND MEASURES: Total hospital charge, length of stay, mortality, pneumonia, respiratory failure, urinary tract infection, urinary retention, anastomotic leak, and postoperative ileus. RESULTS: A total of 191 576 laparoscopic colorectal cases were identified during the study period. Epidural analgesia was used in 4102 cases (2.14%). Epidurals were more likely to be used in large teaching hospitals, cancer cases, and rectal operations. On case-matched analysis, epidural analgesia was associated with a longer hospital stay by 0.60 day (P = .003), higher hospital charges by $3732.71 (P = .02), and higher rate of urinary tract infection (odds ratio = 1.81; P = .05). Epidural analgesia did not affect the incidence of respiratory failure, pneumonia, anastomotic leak, ileus, or urinary retention. CONCLUSIONS AND RELEVANCE: The perioperative use of epidural analgesia in laparoscopic colorectal surgery is limited in the United States. While epidural analgesia appears to be safe, it comes with higher hospital charges, longer hospital stay, and a higher incidence of urinary tract infections.

AB - IMPORTANCE: The use of epidural analgesia in laparoscopic colorectal surgery has demonstrated superiority over conventional analgesia in controlling pain. Controversy exists, however, regarding its cost-effectiveness and its effect on postoperative outcomes. OBJECTIVES: To examine the use of epidural analgesia in laparoscopic colorectal surgery at the national level and to compare its outcomes with those of conventional analgesia. DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective review of laparoscopic colorectal cases performed with or without epidural analgesia for cancer, diverticular disease, and benign polyps. Patient demographic characteristics, disease and procedure types, and hospital settings were listed for patients in the epidural and conventional analgesia groups. A 1 to 4 case-matched analysis was performed, matching for patient demographic characteristics, hospital setting, indications, and procedure type. Data were obtained from the Nationwide Inpatient Sample between January 1, 2002, and December 31, 2010. MAIN OUTCOMES AND MEASURES: Total hospital charge, length of stay, mortality, pneumonia, respiratory failure, urinary tract infection, urinary retention, anastomotic leak, and postoperative ileus. RESULTS: A total of 191 576 laparoscopic colorectal cases were identified during the study period. Epidural analgesia was used in 4102 cases (2.14%). Epidurals were more likely to be used in large teaching hospitals, cancer cases, and rectal operations. On case-matched analysis, epidural analgesia was associated with a longer hospital stay by 0.60 day (P = .003), higher hospital charges by $3732.71 (P = .02), and higher rate of urinary tract infection (odds ratio = 1.81; P = .05). Epidural analgesia did not affect the incidence of respiratory failure, pneumonia, anastomotic leak, ileus, or urinary retention. CONCLUSIONS AND RELEVANCE: The perioperative use of epidural analgesia in laparoscopic colorectal surgery is limited in the United States. While epidural analgesia appears to be safe, it comes with higher hospital charges, longer hospital stay, and a higher incidence of urinary tract infections.

UR - http://www.scopus.com/inward/record.url?scp=84894571982&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84894571982&partnerID=8YFLogxK

U2 - 10.1001/jamasurg.2013.3186

DO - 10.1001/jamasurg.2013.3186

M3 - Article

C2 - 24336894

AN - SCOPUS:84894571982

VL - 149

SP - 130

EP - 136

JO - JAMA Surgery

JF - JAMA Surgery

SN - 2168-6254

IS - 2

ER -