Is It Time to Reconsider Postoperative Epidural Analgesia in Patients Undergoing Elective Ventral Hernia Repair?: An AHSQC Analysis

OBJECTIVE:We aimed to evaluate the association of epidural analgesia (EA) with hospital length of stay (LOS), wound morbidity, postoperative complications, and patient-reported outcomes in patients undergoing ventral hernia repair (VHR). BACKGROUND:EA has been shown to reduce LOS in certain surgical...

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Veröffentlicht in:Annals of surgery 2018-05, Vol.267 (5), p.971-976
Hauptverfasser: Prabhu, Ajita S, Krpata, David M, Perez, Arielle, Phillips, Sharon, Huang, Li-Ching, Haskins, Ivy N, Rosenblatt, Steven, Poulose, Benjamin K, Rosen, Michael J
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container_end_page 976
container_issue 5
container_start_page 971
container_title Annals of surgery
container_volume 267
creator Prabhu, Ajita S
Krpata, David M
Perez, Arielle
Phillips, Sharon
Huang, Li-Ching
Haskins, Ivy N
Rosenblatt, Steven
Poulose, Benjamin K
Rosen, Michael J
description OBJECTIVE:We aimed to evaluate the association of epidural analgesia (EA) with hospital length of stay (LOS), wound morbidity, postoperative complications, and patient-reported outcomes in patients undergoing ventral hernia repair (VHR). BACKGROUND:EA has been shown to reduce LOS in certain surgical populations. The LOS benefit in VHR is unclear. METHODS:Patients having VHR performed in the Americas Hernia Society Quality Collaborative (AHSQC) were separated into 2 comparable groups matched on several confounding factors using a propensity score algorithmone group received postoperative EA, and the other did not. The groups were then evaluated for hospital LOS, 30-day wound morbidity, other complications, and 30-day patient-reported outcomes using pain and hernia-specific quality-of-life instruments. RESULTS:A 1:1 match was achieved and the final analysis included 763 patients receiving EA and 763 not receiving EA. The EA group had an increased LOS (5.49 vs 4.90 days; P < 0.05). The rate of wound events was similar between the groups. There was an increased risk of having any postoperative complication associated with having EA (26% vs 21%; P < 0.05). Pain intensity-scaled scores were significantly higher (worse) in the EA group versus the non-EA group (47.6 vs 44.0; P = 0.04). CONCLUSIONS:The LOS benefit of EA noted for other operations may not apply to patients undergoing VHR. Further study is necessary to determine the beneficial role of invasive pain management procedures in this group of patients with an extremely common disease state.
doi_str_mv 10.1097/SLA.0000000000002214
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BACKGROUND:EA has been shown to reduce LOS in certain surgical populations. The LOS benefit in VHR is unclear. METHODS:Patients having VHR performed in the Americas Hernia Society Quality Collaborative (AHSQC) were separated into 2 comparable groups matched on several confounding factors using a propensity score algorithmone group received postoperative EA, and the other did not. The groups were then evaluated for hospital LOS, 30-day wound morbidity, other complications, and 30-day patient-reported outcomes using pain and hernia-specific quality-of-life instruments. RESULTS:A 1:1 match was achieved and the final analysis included 763 patients receiving EA and 763 not receiving EA. The EA group had an increased LOS (5.49 vs 4.90 days; P &lt; 0.05). The rate of wound events was similar between the groups. There was an increased risk of having any postoperative complication associated with having EA (26% vs 21%; P &lt; 0.05). Pain intensity-scaled scores were significantly higher (worse) in the EA group versus the non-EA group (47.6 vs 44.0; P = 0.04). CONCLUSIONS:The LOS benefit of EA noted for other operations may not apply to patients undergoing VHR. Further study is necessary to determine the beneficial role of invasive pain management procedures in this group of patients with an extremely common disease state.</description><identifier>ISSN: 0003-4932</identifier><identifier>EISSN: 1528-1140</identifier><identifier>DOI: 10.1097/SLA.0000000000002214</identifier><identifier>PMID: 28288066</identifier><language>eng</language><publisher>United States: Copyright Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Analgesia, Epidural - methods ; Elective Surgical Procedures ; Female ; Follow-Up Studies ; Hernia, Ventral - surgery ; Herniorrhaphy ; Humans ; Length of Stay - trends ; Male ; Middle Aged ; Morbidity - trends ; Pain, Postoperative - epidemiology ; Pain, Postoperative - therapy ; Patient Reported Outcome Measures ; Postoperative Care - methods ; Propensity Score ; Retrospective Studies ; Societies, Medical ; Time Factors ; United States - epidemiology</subject><ispartof>Annals of surgery, 2018-05, Vol.267 (5), p.971-976</ispartof><rights>Copyright © 2018 Wolters Kluwer Health, Inc. 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BACKGROUND:EA has been shown to reduce LOS in certain surgical populations. The LOS benefit in VHR is unclear. METHODS:Patients having VHR performed in the Americas Hernia Society Quality Collaborative (AHSQC) were separated into 2 comparable groups matched on several confounding factors using a propensity score algorithmone group received postoperative EA, and the other did not. The groups were then evaluated for hospital LOS, 30-day wound morbidity, other complications, and 30-day patient-reported outcomes using pain and hernia-specific quality-of-life instruments. RESULTS:A 1:1 match was achieved and the final analysis included 763 patients receiving EA and 763 not receiving EA. The EA group had an increased LOS (5.49 vs 4.90 days; P &lt; 0.05). The rate of wound events was similar between the groups. There was an increased risk of having any postoperative complication associated with having EA (26% vs 21%; P &lt; 0.05). Pain intensity-scaled scores were significantly higher (worse) in the EA group versus the non-EA group (47.6 vs 44.0; P = 0.04). CONCLUSIONS:The LOS benefit of EA noted for other operations may not apply to patients undergoing VHR. Further study is necessary to determine the beneficial role of invasive pain management procedures in this group of patients with an extremely common disease state.</description><subject>Analgesia, Epidural - methods</subject><subject>Elective Surgical Procedures</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hernia, Ventral - surgery</subject><subject>Herniorrhaphy</subject><subject>Humans</subject><subject>Length of Stay - trends</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Morbidity - trends</subject><subject>Pain, Postoperative - epidemiology</subject><subject>Pain, Postoperative - therapy</subject><subject>Patient Reported Outcome Measures</subject><subject>Postoperative Care - methods</subject><subject>Propensity Score</subject><subject>Retrospective Studies</subject><subject>Societies, Medical</subject><subject>Time Factors</subject><subject>United States - epidemiology</subject><issn>0003-4932</issn><issn>1528-1140</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEFP2zAYhq1paO26_QOEfNwlYDtO7O4yVVVZK1WCFbpr5DhfWm9uHOwExJk_jkvLhHbAF0v-nvf95AehU0rOKRmLi5vl5Jy8OYxR_gENacZkQiknH9EwvqYJH6dsgD6H8IcQyiURn9CASSYlyfMheloEvOjwrdkB7hxegXZNMBV4fO1C51rwqjP3gGetqXqvLJ40ym4gGIVNg6_jEJou4HUTIxtnmg2eWdAvkd9xsk_MwTcRX0GrjP_xPTbgyfzm1_Sl6jGY8AWd1MoG-Hq8R2h9ObudzpPl1c_FdLJMNEsznkiux5Jksq6YZopXgouq5FmmGRF5CqVQugauajEGldaiLLmGPKey3H9WRw0j9O3Q23p310Poip0JGqxVDbg-FFQKkbGM5Cyi_IBq70LwUBetNzvlHwtKir3-Iuov_tcfY2fHDX25g-pf6NV3BOQBeHC2Ax_-2v4BfLEFZbvt-93PcWKRlA</recordid><startdate>201805</startdate><enddate>201805</enddate><creator>Prabhu, Ajita S</creator><creator>Krpata, David M</creator><creator>Perez, Arielle</creator><creator>Phillips, Sharon</creator><creator>Huang, Li-Ching</creator><creator>Haskins, Ivy N</creator><creator>Rosenblatt, Steven</creator><creator>Poulose, Benjamin K</creator><creator>Rosen, Michael J</creator><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201805</creationdate><title>Is It Time to Reconsider Postoperative Epidural Analgesia in Patients Undergoing Elective Ventral Hernia Repair?: An AHSQC Analysis</title><author>Prabhu, Ajita S ; Krpata, David M ; Perez, Arielle ; Phillips, Sharon ; Huang, Li-Ching ; Haskins, Ivy N ; Rosenblatt, Steven ; Poulose, Benjamin K ; Rosen, Michael J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2354-84c98058fd2c2a4d747db455c20763eb7acfe4af79ea3f7bb4ce6618b8288c493</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Analgesia, Epidural - methods</topic><topic>Elective Surgical Procedures</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Hernia, Ventral - surgery</topic><topic>Herniorrhaphy</topic><topic>Humans</topic><topic>Length of Stay - trends</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Morbidity - trends</topic><topic>Pain, Postoperative - epidemiology</topic><topic>Pain, Postoperative - therapy</topic><topic>Patient Reported Outcome Measures</topic><topic>Postoperative Care - methods</topic><topic>Propensity Score</topic><topic>Retrospective Studies</topic><topic>Societies, Medical</topic><topic>Time Factors</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Prabhu, Ajita S</creatorcontrib><creatorcontrib>Krpata, David M</creatorcontrib><creatorcontrib>Perez, Arielle</creatorcontrib><creatorcontrib>Phillips, Sharon</creatorcontrib><creatorcontrib>Huang, Li-Ching</creatorcontrib><creatorcontrib>Haskins, Ivy N</creatorcontrib><creatorcontrib>Rosenblatt, Steven</creatorcontrib><creatorcontrib>Poulose, Benjamin K</creatorcontrib><creatorcontrib>Rosen, Michael J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Prabhu, Ajita S</au><au>Krpata, David M</au><au>Perez, Arielle</au><au>Phillips, Sharon</au><au>Huang, Li-Ching</au><au>Haskins, Ivy N</au><au>Rosenblatt, Steven</au><au>Poulose, Benjamin K</au><au>Rosen, Michael J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is It Time to Reconsider Postoperative Epidural Analgesia in Patients Undergoing Elective Ventral Hernia Repair?: An AHSQC Analysis</atitle><jtitle>Annals of surgery</jtitle><addtitle>Ann Surg</addtitle><date>2018-05</date><risdate>2018</risdate><volume>267</volume><issue>5</issue><spage>971</spage><epage>976</epage><pages>971-976</pages><issn>0003-4932</issn><eissn>1528-1140</eissn><abstract>OBJECTIVE:We aimed to evaluate the association of epidural analgesia (EA) with hospital length of stay (LOS), wound morbidity, postoperative complications, and patient-reported outcomes in patients undergoing ventral hernia repair (VHR). 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Pain intensity-scaled scores were significantly higher (worse) in the EA group versus the non-EA group (47.6 vs 44.0; P = 0.04). CONCLUSIONS:The LOS benefit of EA noted for other operations may not apply to patients undergoing VHR. Further study is necessary to determine the beneficial role of invasive pain management procedures in this group of patients with an extremely common disease state.</abstract><cop>United States</cop><pub>Copyright Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>28288066</pmid><doi>10.1097/SLA.0000000000002214</doi><tpages>6</tpages></addata></record>
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subjects Analgesia, Epidural - methods
Elective Surgical Procedures
Female
Follow-Up Studies
Hernia, Ventral - surgery
Herniorrhaphy
Humans
Length of Stay - trends
Male
Middle Aged
Morbidity - trends
Pain, Postoperative - epidemiology
Pain, Postoperative - therapy
Patient Reported Outcome Measures
Postoperative Care - methods
Propensity Score
Retrospective Studies
Societies, Medical
Time Factors
United States - epidemiology
title Is It Time to Reconsider Postoperative Epidural Analgesia in Patients Undergoing Elective Ventral Hernia Repair?: An AHSQC Analysis
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