Epidural Analgesia Is Associated with Prolonged Length of Stay After Open HPB Surgery in Over 27,000 Patients
Background The impact of epidural analgesia (EA) on postoperative morbidity and length of stay (LOS) after HPB surgery remains to be determined. These specific outcomes have been highlighted by the implementation of multiple enhanced recovery pathways (ERAS). The authors hypothesized that EA in the...
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| Veröffentlicht in: | Journal of gastrointestinal surgery 2021-07, Vol.25 (7), p.1716-1726 |
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| creator | Kone, Lyonell B. Maker, Vijay K. Banulescu, Mihaela Maker, Ajay V. |
| description | Background
The impact of epidural analgesia (EA) on postoperative morbidity and length of stay (LOS) after HPB surgery remains to be determined. These specific outcomes have been highlighted by the implementation of multiple enhanced recovery pathways (ERAS). The authors hypothesized that EA in the current environment may be associated with LOS and other outcomes.
Methods
The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) databases from 2014 to 2017 for patients undergoing open hepatopancreaticobiliary (HPB) surgery were included in a retrospective cohort analysis with propensity score matching (PSM) comparing EA with control.
Results
Twenty-seven thousand two hundred eighteen patients underwent open HPB surgery, of which 6048 (22%) received EA. There was an increase use of EA over time (from 19.3 to 25.5%,
p
= 0.001). On PSM, EA was associated with more than half of a day increase in LOS for both pancreatic (
p |
| doi_str_mv | 10.1007/s11605-020-04751-y |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2428418296</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2550485387</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-927fde110aa2b455d8f17d2d575d9e0cc095fc60626666b1d427e819fc51bbd33</originalsourceid><addsrcrecordid>eNqNkUFr3DAQhUVpaZJN_0APRdBLoXU7ki3LPm6WpAks7EJS6M3IkrxV8FpbSW7wv-8kTlPooUQXSaPvDZr3CHnL4DMDkF8iYyWIDDhkUEjBsukFOWaVzLOi5OVLPEPNMi7E9yNyEuMtAJPAqtfkKOcSy6w-JvvzgzNjUD1dDqrf2egUvYp0GaPXTiVr6J1LP-g2-N4PO7yu7bDDgu_odVITXXbJBro52IFebs_o9Rh2NkzUDXTzCx-4_AQAdKuSs0OKp-RVp_po3zzuC_Lt4vxmdZmtN1-vVst1pnMpUlZz2RnLGCjF20IIU3VMGm6EFKa2oDXUotMl4JS4WmYKLm3F6k4L1rYmzxfkw9z3EPzP0cbU7F3Utu_VYP0YG17wqmAVr0tE3_-D3voxoBdICQFFJXJ0dEH4TOngYwy2aw7B7VWYGgbNfRjNHEaDYTQPYTQTit49th7bvTVPkj_uI1DNwJ1tfRc1eqTtE4bGCZHnhYD7xVcuoYt-WPlxSCj9-Hwp0vlMRyQwxvB3yP_8_ze7aLOZ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2550485387</pqid></control><display><type>article</type><title>Epidural Analgesia Is Associated with Prolonged Length of Stay After Open HPB Surgery in Over 27,000 Patients</title><source>MEDLINE</source><source>SpringerNature Journals</source><source>Web of Science - Science Citation Index Expanded - 2021<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /></source><creator>Kone, Lyonell B. ; Maker, Vijay K. ; Banulescu, Mihaela ; Maker, Ajay V.</creator><creatorcontrib>Kone, Lyonell B. ; Maker, Vijay K. ; Banulescu, Mihaela ; Maker, Ajay V.</creatorcontrib><description>Background
The impact of epidural analgesia (EA) on postoperative morbidity and length of stay (LOS) after HPB surgery remains to be determined. These specific outcomes have been highlighted by the implementation of multiple enhanced recovery pathways (ERAS). The authors hypothesized that EA in the current environment may be associated with LOS and other outcomes.
Methods
The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) databases from 2014 to 2017 for patients undergoing open hepatopancreaticobiliary (HPB) surgery were included in a retrospective cohort analysis with propensity score matching (PSM) comparing EA with control.
Results
Twenty-seven thousand two hundred eighteen patients underwent open HPB surgery, of which 6048 (22%) received EA. There was an increase use of EA over time (from 19.3 to 25.5%,
p
= 0.001). On PSM, EA was associated with more than half of a day increase in LOS for both pancreatic (
p
< 0.001) and hepatic surgery (
p
< 0.001). Furthermore, for pancreatic surgery, there was an increase in urinary tract infection (2.5% vs. 3.3%,
p
= 0.018), time to drain removal (7.8 vs. 8.7 days,
p
< 0.001), and discharge to rehabilitation (2.9% vs. 4.3%,
p
= 0.029). For hepatic surgery, there was an increase in blood transfusion requirements (17% vs. 20%,
p
= 0.019). There were no differences in overall morbidity and mortality.
Conclusion
In this cohort of over 27,000 patients with granular surgical details, there was a significant increase in LOS associated with EA after HPB surgery, along with increased procedure-specific UTI and blood transfusion. With the ever-increasing need for standardized and efficient patient care pathways that reduce LOS, alternative analgesic adjuncts may be considered to optimize patient outcomes.</description><identifier>ISSN: 1091-255X</identifier><identifier>EISSN: 1873-4626</identifier><identifier>DOI: 10.1007/s11605-020-04751-y</identifier><identifier>PMID: 32725519</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal surgery ; Analgesia, Epidural ; Blood transfusions ; Digestive System Surgical Procedures ; Epidural ; Gastroenterology ; Gastroenterology & Hepatology ; Humans ; Length of Stay ; Life Sciences & Biomedicine ; Medicine ; Medicine & Public Health ; Original Article ; Patient Discharge ; Patients ; Recovery (Medical) ; Retrospective Studies ; Science & Technology ; Surgery</subject><ispartof>Journal of gastrointestinal surgery, 2021-07, Vol.25 (7), p.1716-1726</ispartof><rights>The Society for Surgery of the Alimentary Tract 2020</rights><rights>2020. The Society for Surgery of the Alimentary Tract.</rights><rights>The Society for Surgery of the Alimentary Tract 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>6</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000553345000002</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c375t-927fde110aa2b455d8f17d2d575d9e0cc095fc60626666b1d427e819fc51bbd33</citedby><cites>FETCH-LOGICAL-c375t-927fde110aa2b455d8f17d2d575d9e0cc095fc60626666b1d427e819fc51bbd33</cites><orcidid>0000-0002-8234-2762</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11605-020-04751-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11605-020-04751-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,782,786,27931,27932,39265,41495,42564,51326</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32725519$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kone, Lyonell B.</creatorcontrib><creatorcontrib>Maker, Vijay K.</creatorcontrib><creatorcontrib>Banulescu, Mihaela</creatorcontrib><creatorcontrib>Maker, Ajay V.</creatorcontrib><title>Epidural Analgesia Is Associated with Prolonged Length of Stay After Open HPB Surgery in Over 27,000 Patients</title><title>Journal of gastrointestinal surgery</title><addtitle>J Gastrointest Surg</addtitle><addtitle>J GASTROINTEST SURG</addtitle><addtitle>J Gastrointest Surg</addtitle><description>Background
The impact of epidural analgesia (EA) on postoperative morbidity and length of stay (LOS) after HPB surgery remains to be determined. These specific outcomes have been highlighted by the implementation of multiple enhanced recovery pathways (ERAS). The authors hypothesized that EA in the current environment may be associated with LOS and other outcomes.
Methods
The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) databases from 2014 to 2017 for patients undergoing open hepatopancreaticobiliary (HPB) surgery were included in a retrospective cohort analysis with propensity score matching (PSM) comparing EA with control.
Results
Twenty-seven thousand two hundred eighteen patients underwent open HPB surgery, of which 6048 (22%) received EA. There was an increase use of EA over time (from 19.3 to 25.5%,
p
= 0.001). On PSM, EA was associated with more than half of a day increase in LOS for both pancreatic (
p
< 0.001) and hepatic surgery (
p
< 0.001). Furthermore, for pancreatic surgery, there was an increase in urinary tract infection (2.5% vs. 3.3%,
p
= 0.018), time to drain removal (7.8 vs. 8.7 days,
p
< 0.001), and discharge to rehabilitation (2.9% vs. 4.3%,
p
= 0.029). For hepatic surgery, there was an increase in blood transfusion requirements (17% vs. 20%,
p
= 0.019). There were no differences in overall morbidity and mortality.
Conclusion
In this cohort of over 27,000 patients with granular surgical details, there was a significant increase in LOS associated with EA after HPB surgery, along with increased procedure-specific UTI and blood transfusion. With the ever-increasing need for standardized and efficient patient care pathways that reduce LOS, alternative analgesic adjuncts may be considered to optimize patient outcomes.</description><subject>Abdominal surgery</subject><subject>Analgesia, Epidural</subject><subject>Blood transfusions</subject><subject>Digestive System Surgical Procedures</subject><subject>Epidural</subject><subject>Gastroenterology</subject><subject>Gastroenterology & Hepatology</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Life Sciences & Biomedicine</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Article</subject><subject>Patient Discharge</subject><subject>Patients</subject><subject>Recovery (Medical)</subject><subject>Retrospective Studies</subject><subject>Science & Technology</subject><subject>Surgery</subject><issn>1091-255X</issn><issn>1873-4626</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>HGBXW</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNkUFr3DAQhUVpaZJN_0APRdBLoXU7ki3LPm6WpAks7EJS6M3IkrxV8FpbSW7wv-8kTlPooUQXSaPvDZr3CHnL4DMDkF8iYyWIDDhkUEjBsukFOWaVzLOi5OVLPEPNMi7E9yNyEuMtAJPAqtfkKOcSy6w-JvvzgzNjUD1dDqrf2egUvYp0GaPXTiVr6J1LP-g2-N4PO7yu7bDDgu_odVITXXbJBro52IFebs_o9Rh2NkzUDXTzCx-4_AQAdKuSs0OKp-RVp_po3zzuC_Lt4vxmdZmtN1-vVst1pnMpUlZz2RnLGCjF20IIU3VMGm6EFKa2oDXUotMl4JS4WmYKLm3F6k4L1rYmzxfkw9z3EPzP0cbU7F3Utu_VYP0YG17wqmAVr0tE3_-D3voxoBdICQFFJXJ0dEH4TOngYwy2aw7B7VWYGgbNfRjNHEaDYTQPYTQTit49th7bvTVPkj_uI1DNwJ1tfRc1eqTtE4bGCZHnhYD7xVcuoYt-WPlxSCj9-Hwp0vlMRyQwxvB3yP_8_ze7aLOZ</recordid><startdate>20210701</startdate><enddate>20210701</enddate><creator>Kone, Lyonell B.</creator><creator>Maker, Vijay K.</creator><creator>Banulescu, Mihaela</creator><creator>Maker, Ajay V.</creator><general>Springer US</general><general>Springer Nature</general><general>Springer Nature B.V</general><scope>BLEPL</scope><scope>DTL</scope><scope>HGBXW</scope><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>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8234-2762</orcidid></search><sort><creationdate>20210701</creationdate><title>Epidural Analgesia Is Associated with Prolonged Length of Stay After Open HPB Surgery in Over 27,000 Patients</title><author>Kone, Lyonell B. ; Maker, Vijay K. ; Banulescu, Mihaela ; Maker, Ajay V.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-927fde110aa2b455d8f17d2d575d9e0cc095fc60626666b1d427e819fc51bbd33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Abdominal surgery</topic><topic>Analgesia, Epidural</topic><topic>Blood transfusions</topic><topic>Digestive System Surgical Procedures</topic><topic>Epidural</topic><topic>Gastroenterology</topic><topic>Gastroenterology & Hepatology</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>Life Sciences & Biomedicine</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Article</topic><topic>Patient Discharge</topic><topic>Patients</topic><topic>Recovery (Medical)</topic><topic>Retrospective Studies</topic><topic>Science & Technology</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kone, Lyonell B.</creatorcontrib><creatorcontrib>Maker, Vijay K.</creatorcontrib><creatorcontrib>Banulescu, Mihaela</creatorcontrib><creatorcontrib>Maker, Ajay V.</creatorcontrib><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Web of Science - Science Citation Index Expanded - 2021</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastrointestinal surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kone, Lyonell B.</au><au>Maker, Vijay K.</au><au>Banulescu, Mihaela</au><au>Maker, Ajay V.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Epidural Analgesia Is Associated with Prolonged Length of Stay After Open HPB Surgery in Over 27,000 Patients</atitle><jtitle>Journal of gastrointestinal surgery</jtitle><stitle>J Gastrointest Surg</stitle><stitle>J GASTROINTEST SURG</stitle><addtitle>J Gastrointest Surg</addtitle><date>2021-07-01</date><risdate>2021</risdate><volume>25</volume><issue>7</issue><spage>1716</spage><epage>1726</epage><pages>1716-1726</pages><issn>1091-255X</issn><eissn>1873-4626</eissn><abstract>Background
The impact of epidural analgesia (EA) on postoperative morbidity and length of stay (LOS) after HPB surgery remains to be determined. These specific outcomes have been highlighted by the implementation of multiple enhanced recovery pathways (ERAS). The authors hypothesized that EA in the current environment may be associated with LOS and other outcomes.
Methods
The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) databases from 2014 to 2017 for patients undergoing open hepatopancreaticobiliary (HPB) surgery were included in a retrospective cohort analysis with propensity score matching (PSM) comparing EA with control.
Results
Twenty-seven thousand two hundred eighteen patients underwent open HPB surgery, of which 6048 (22%) received EA. There was an increase use of EA over time (from 19.3 to 25.5%,
p
= 0.001). On PSM, EA was associated with more than half of a day increase in LOS for both pancreatic (
p
< 0.001) and hepatic surgery (
p
< 0.001). Furthermore, for pancreatic surgery, there was an increase in urinary tract infection (2.5% vs. 3.3%,
p
= 0.018), time to drain removal (7.8 vs. 8.7 days,
p
< 0.001), and discharge to rehabilitation (2.9% vs. 4.3%,
p
= 0.029). For hepatic surgery, there was an increase in blood transfusion requirements (17% vs. 20%,
p
= 0.019). There were no differences in overall morbidity and mortality.
Conclusion
In this cohort of over 27,000 patients with granular surgical details, there was a significant increase in LOS associated with EA after HPB surgery, along with increased procedure-specific UTI and blood transfusion. With the ever-increasing need for standardized and efficient patient care pathways that reduce LOS, alternative analgesic adjuncts may be considered to optimize patient outcomes.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>32725519</pmid><doi>10.1007/s11605-020-04751-y</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-8234-2762</orcidid></addata></record> |
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| language | eng |
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| subjects | Abdominal surgery Analgesia, Epidural Blood transfusions Digestive System Surgical Procedures Epidural Gastroenterology Gastroenterology & Hepatology Humans Length of Stay Life Sciences & Biomedicine Medicine Medicine & Public Health Original Article Patient Discharge Patients Recovery (Medical) Retrospective Studies Science & Technology Surgery |
| title | Epidural Analgesia Is Associated with Prolonged Length of Stay After Open HPB Surgery in Over 27,000 Patients |
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