Federico Piccioni1, Luigi Mariani2, Marta Negri3, Claudia Casiraghi4, Filiberto Belli5, Ermanno Leo5, Martin Langer1,6. 1. Department of Anesthesia, Intensive Care and Palliative Care, Fondazione Istituto Nazionale dei Tumori, Milan, Italy. 2. Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 3. Anesthesia and Intensive Care Unit, Azienda Ospedaliera Treviglio, Treviglio, Italy. 4. School of Anesthesia and Intensive Care, University of Milan, Milan, Italy. 5. Colorectal Cancer Unit-Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 6. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
Abstract
BACKGROUND: Anastomotic leakage is a major cause of morbidity after colorectal surgery. Epidural analgesia is the most effective method for postoperative pain relief after major abdominal surgery. Anyhow, its effect on anastomotic leakage rate is still controversial. This study aimed to compare epidural versus intravenous analgesia as risk factor for anastomotic leakage requiring reoperation in patients undergoing open colorectal surgery for cancer. METHODS: A retrospective study on 1,474 patients was performed. The Cox proportional hazards model was used to study the relation between primary and secondary factors of risk and anastomotic leakage occurrence within 30 days after elective operation. RESULTS: Overall 30-day anastomotic leakage requiring reoperation was 4.9% (95%CI: 3.8-6.0%). No difference in anastomotic leakage occurrence was observed between the epidural analgesia group and the intravenous analgesia group (Hazard ratio: 0.94; 95%CI: 0.53-1.67%; P = 0.8338). Females had a rate of anastomotic leakage 43% lower than males (P = 0.0301). The diverting stoma resulted to be protective for anastomotic leakage occurrence (P = 0.0052). AL significantly increased postoperative median length of stay but not in-hospital mortality. CONCLUSIONS: Epidural analgesia does not influence the AL risk after open colorectal surgery for cancer.
BACKGROUND:Anastomotic leakage is a major cause of morbidity after colorectal surgery. Epidural analgesia is the most effective method for postoperative pain relief after major abdominal surgery. Anyhow, its effect on anastomotic leakage rate is still controversial. This study aimed to compare epidural versus intravenous analgesia as risk factor for anastomotic leakage requiring reoperation in patients undergoing open colorectal surgery for cancer. METHODS: A retrospective study on 1,474 patients was performed. The Cox proportional hazards model was used to study the relation between primary and secondary factors of risk and anastomotic leakage occurrence within 30 days after elective operation. RESULTS: Overall 30-day anastomotic leakage requiring reoperation was 4.9% (95%CI: 3.8-6.0%). No difference in anastomotic leakage occurrence was observed between the epidural analgesia group and the intravenous analgesia group (Hazard ratio: 0.94; 95%CI: 0.53-1.67%; P = 0.8338). Females had a rate of anastomotic leakage 43% lower than males (P = 0.0301). The diverting stoma resulted to be protective for anastomotic leakage occurrence (P = 0.0052). AL significantly increased postoperative median length of stay but not in-hospital mortality. CONCLUSIONS: Epidural analgesia does not influence the AL risk after open colorectal surgery for cancer.
Authors: N M Verweij; M E Hamaker; D D E Zimmerman; Y T van Loon; F van den Bos; A Pronk; I H M Borel Rinkes; A H W Schiphorst Journal: Int J Colorectal Dis Date: 2016-10-08 Impact factor: 2.571
Authors: Andrea Romanzi; Nicola Boleso; Giuseppe Di Palma; Davide La Regina; Francesco Mongelli; Maria Milanesi; Antonella Putortì; Fabrizio Rossi; Roberta Scolaro; Michel Zanardo; Alberto Vannelli Journal: Pain Res Manag Date: 2021-02-22 Impact factor: 3.037