Original Article

Journal of Gastrointestinal Surgery

, Volume 17, Issue 6, pp 1130-1137

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

  • Wissam J. HalabiAffiliated withDepartment of Surgery, University of California, Irvine School of Medicine
  • , Mehraneh D. JafariAffiliated withDepartment of Surgery, University of California, Irvine School of Medicine
  • , Vinh Q. NguyenAffiliated withDepartment of Statistics, University of California Irvine
  • , Joseph C. CarmichaelAffiliated withDepartment of Surgery, University of California, Irvine School of Medicine
  • , Steven MillsAffiliated withDepartment of Surgery, University of California, Irvine School of Medicine
  • , Michael J. StamosAffiliated withDepartment of Surgery, University of California, Irvine School of Medicine
  • , Alessio PigazziAffiliated withDepartment of Surgery, University of California, Irvine School of MedicineDepartment of Surgery, University of California, Irvine School of Medicine Email author 

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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.

Keywords

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