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Epidural anesthesia for post-operative pain is associated with a higher incidence of complications following open ventral hernia repair

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Abstract

Introduction

Ventral/incisional hernia repair is a common procedure. Epidural anesthesia for post-operative pain control has been used to attempt to limit opioids. The complications associated with epidural anesthesia are starting to be recognized in open ventral hernia repair patients.

Methods

Data were abstracted from the National Surgical Quality Improvement Program (NSQIP) participant use data file for 2015. Adult patients with an open ventral hernia repair were identified. In an effort to identify complex hernias, patients who required the implantation of mesh and remained inpatient for 2 or more days were included. Patients with epidural anesthesia and general anesthesia (epidural group) were compared to those with general anesthesia alone (non-epidural). Descriptive statistics and complications were recorded and compared.

Results

A total of 1943 patients met inclusion criteria: 1009 patients (51.9%) in the non-epidural group and 934 (48.1%) in the epidural group. There were fewer clean cases in the epidural group (63.2%) than the non-epidural group (68.8%, p = 0.007). Otherwise, there was no difference in gender, age, body mass index, American Society of Anesthesiologists physical status, and current smoking status. There were more pulmonary emboli in the epidural group (1.39%) compared to the non-epidural group (0.50%, p = 0.04). Urinary tract infection was also significantly higher in the epidural group (3.10%) compared to the non-epidural group (1.59%, p = 0.03). Transfusions were also administered to more of the epidural patients (5.14%) compared to non-epidural patients (2.78%, p = 0.007). The rates of other post-operative complications were not statistically significant between the two groups. Total length of stay in the hospital was also greater in the epidural group (6.7 vs. 5.0 days, p < 0.0001).

Conclusions

This is an association with the use of epidural anesthesia in open ventral hernia repairs and an increased incidence of pulmonary emboli, transfusions, and urinary tract infections, as well as an increased length of stay.

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References

  1. Poulose BK, Shelton J, Phillips S, Moore D, Nealon W, Penson D et al (2012) Epidemiology and cost of ventral hernia repair: making the case for hernia research. Hernia 16(2):179–183

    Article  CAS  Google Scholar 

  2. Dominic S (2007) Core topics in general and emergency surgery (3rd edn). Annals of the Royal College of Surgeons of England. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2121276/

  3. Kokotovic D, Sjølander H, Gögenur I, Helgstrand F (2017) Correlation between early surgical complications and readmission rate after ventral hernia repair. Hernia 21:1–6

    Google Scholar 

  4. Kulacoglu H (2011) Current options in inguinal hernia repair in adult patients. Hippokratia 15(3):223–231

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Yang B, Liang M-J, Zhang Y-C (2008) Use of local or epidural anesthesia in inguinal hernia repair: a randomized trial. Zhonghua wai ke za zhi [Chin J Surg] 46(16):1234–1236

    Google Scholar 

  6. Park WY, Thompson JS, Lee KK (2001) Effect of epidural anesthesia and analgesia on perioperative outcome: a randomized, controlled Veterans Affairs cooperative study. Ann Surg 234(4):560

    Article  CAS  Google Scholar 

  7. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A et al (2000) Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 321:1–12

    Article  Google Scholar 

  8. Moraca RJ, Sheldon DG, Thirlby RC (2003) The role of epidural anesthesia and analgesia in surgical practice. Ann Surg 238(5):663–673

    Article  Google Scholar 

  9. Freise H, Van Aken HK (2011) Risks and benefits of thoracic epidural anaesthesia. Br J Anaesth 107(6):859–868

    Article  CAS  Google Scholar 

  10. Tapson VF (2008) Acute pulmonary embolism. N Engl J Med 358(10):1037–1052

    Article  CAS  Google Scholar 

  11. Hall D (2013) Perioperative pulmonary embolism: detection, treatment, and outcomes. Am J Ther 20(1):67–72

    Article  Google Scholar 

  12. Koch CG, Li L, Hixson E, Tang A, Phillips S, Henderson JM (2012) What are the real rates of postoperative complications : elucidating inconsistencies between administrative and clinical data sources. J Am Coll Surg 214(5):798–805

    Article  Google Scholar 

  13. Choi S, Awad I (2013) Maintaining micturition in the perioperative period: strategies to avoid urinary retention. Curr Opin Anaesthesiol 26(3):361–367

    Article  CAS  Google Scholar 

  14. Faas CL, Acosta FJ, Campbell MDR, O’Hagan CE, Newton SE, Zagalaniczny K (2002) The effects of spinal anesthesia vs epidural anesthesia on 3 potential postoperative complications: pain, urinary retention, and mobility following inguinal herniorrhaphy. J Am Assoc Nurse Anesth 70(6):441–447

    Google Scholar 

  15. Wald HL, Ma A, Bratzler DW, Kramer AM (2012) Indwelling urinary catheter use in the postoperative period. Arch Surg 143(6):551–557

    Article  Google Scholar 

  16. Holte K, Foss NB, Svensén C, Lund C, Madsen JL et al (2004) Epidural anesthesia, hypotension, and changes in intravascular volume. Anesthesiology 100(2):281–286

    Article  Google Scholar 

  17. Liumbruno G, Bennardello F, Lattanzio A, Piccoli P, Rossetti G (2009) Recommendations for the transfusion of red blood cells. Blood Transfus 7(1):49–64

    PubMed  PubMed Central  Google Scholar 

  18. Prabhu AS, Krpata DM, Perez A, Phillips S, Huang L-C, Haskins IN, et al (2017) Is it time to reconsider postoperative epidural analgesia in patients undergoing elective ventral hernia repair?: An AHSQC Analysis. Ann Surg XX(Xx):1. http://insights.ovid.com/crossref?an=00000658-900000000-96189%5Cn, http://insights.ovid.com/crossref?an=00000658-900000000-96189%5Cn

  19. Butler AR, Frelich MJ, Gould JC, Goldblatt MI (2014) Laparoscopic hernia complexity predicts operative time and length of stay. Hernia 18(6):791–796

    Article  CAS  Google Scholar 

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Funding

This research was funded by the Department of Surgery, Medical College of Wisconsin.

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Authors and Affiliations

  1. Department of Surgery, Medical College of Wisconsin, 8701 W. Watertown Plank Rd, Milwaukee, WI, 53226, USA

    Steven L. Zhou, Melissa C. Helm & Matthew I. Goldblatt

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  1. Steven L. Zhou
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  2. Melissa C. Helm
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  3. Matthew I. Goldblatt
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Corresponding author

Correspondence to Matthew I. Goldblatt.

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Disclosures

Matthew Goldblatt is a consultant and speaker for WL Gore. He is a consultant, speaker and researcher for Medtronic, a researcher for Bard/Davol, and a consultant for Allergan. None of these relationships are potential conflicts with this study. Steven Zhou and Melissa Helm have no potential conflict of interest or financial ties to disclose.

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Zhou, S.L., Helm, M.C. & Goldblatt, M.I. Epidural anesthesia for post-operative pain is associated with a higher incidence of complications following open ventral hernia repair. Surg Endosc 34, 3527–3532 (2020). https://doi.org/10.1007/s00464-019-07136-8

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  • DOI: https://doi.org/10.1007/s00464-019-07136-8

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