BACKGROUND: The aim of this study was to compare morbidity and mortality of patients who had epidural analgesia for at least 2 days after transthoracic esophagectomy for cancer with those who did not have epidural analgesia at all or who had it for less than 2 days. STUDY DESIGN: We analyzed 182 patients, 7 of whom were excluded. Patients were divided into two groups; 90 patients (51%) with epidural analgesia for at least 2 days (epidural group) and 85 patients (49%) who did not have epidural analgesia or had it for less than 2 days (no epidural group). To identify prognostic factors for pneumonia, univariate and multivariate logistic regression analyses were performed. RESULTS: There were no notable differences in clinicopathologic characteristics or intraoperative measurements. In favor of the epidural group, marked differences were found in pneumonia (28% versus 48%, p = 0.005), reintubation (17% versus 34%, p = 0.011), ICU-stay (median 2.8 versus 5.8 days, p = 0.001), hospital stay (median 17 versus 21 days, p = 0.015), and in-hospital mortality (0 versus 8 patients, p = 0.003). No epidural analgesia (odds ratio [OR] 2.48, 95% CI 1.30 to 4.71, p = 0.006) and atelectasis (OR 2.06, 95% CI 1.08 to 3.90, p = 0.028) were independent predictors for pneumonia. There were eight in-hospital deaths. CONCLUSIONS: No epidural analgesia for more than 2 days after a transthoracic esophageal cancer resection is associated with increased postoperative morbidity. To optimize postoperative recovery, it is of vital importance to ensure adequate epidural analgesia in these patients.
BACKGROUND: The aim of this study was to compare morbidity and mortality of patients who had epidural analgesia for at least 2 days after transthoracic esophagectomy for cancer with those who did not have epidural analgesia at all or who had it for less than 2 days. STUDY DESIGN: We analyzed 182 patients, 7 of whom were excluded. Patients were divided into two groups; 90 patients (51%) with epidural analgesia for at least 2 days (epidural group) and 85 patients (49%) who did not have epidural analgesia or had it for less than 2 days (no epidural group). To identify prognostic factors for pneumonia, univariate and multivariate logistic regression analyses were performed. RESULTS: There were no notable differences in clinicopathologic characteristics or intraoperative measurements. In favor of the epidural group, marked differences were found in pneumonia (28% versus 48%, p = 0.005), reintubation (17% versus 34%, p = 0.011), ICU-stay (median 2.8 versus 5.8 days, p = 0.001), hospital stay (median 17 versus 21 days, p = 0.015), and in-hospital mortality (0 versus 8 patients, p = 0.003). No epidural analgesia (odds ratio [OR] 2.48, 95% CI 1.30 to 4.71, p = 0.006) and atelectasis (OR 2.06, 95% CI 1.08 to 3.90, p = 0.028) were independent predictors for pneumonia. There were eight in-hospital deaths. CONCLUSIONS: No epidural analgesia for more than 2 days after a transthoracic esophageal cancer resection is associated with increased postoperative morbidity. To optimize postoperative recovery, it is of vital importance to ensure adequate epidural analgesia in these patients.
Authors: Oliver S Eng; Renee L Arlow; Dirk Moore; Chunxia Chen; John E Langenfeld; David A August; Darren R Carpizo Journal: J Surg Res Date: 2015-07-16 Impact factor: 2.192
Authors: M Bludau; A H Hölscher; E Bollschweiler; J M Leers; C A Gutschow; S Brinkmann; W Schröder Journal: Langenbecks Arch Surg Date: 2015-08-08 Impact factor: 3.445