Epidural Analgesia Is Associated with Improved Health Outcomes of Surgical Patients with Chronic Obstructive Pulmonary Disease
Patients with chronic obstructive pulmonary disease (COPD) have increased postoperative morbidity and mortality. Epidural analgesia (EDA) improves postoperative outcome but may worsen postoperative lung function. It is unknown whether patients with COPD benefit from EDA. The objective of this study...
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| Veröffentlicht in: | Anesthesiology (Philadelphia) 2011-08, Vol.115 (2), p.315-321 |
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| creator | VAN LIER, Felix VAN DER GEEST, Patrick J HOEKS, Sanne E VAN GESTEL, Yvette R. B. M HOL, Jaap W SIN, Don D JAN STOLKER, Robert POLDERMANS, Don |
| description | Patients with chronic obstructive pulmonary disease (COPD) have increased postoperative morbidity and mortality. Epidural analgesia (EDA) improves postoperative outcome but may worsen postoperative lung function. It is unknown whether patients with COPD benefit from EDA. The objective of this study was to determine whether patients with COPD undergoing major abdominal surgery benefit from EDA in addition to general anesthesia.
This cohort study included 541 consecutive patients with COPD who underwent major abdominal surgery between 1995 and 2007 at a university medical center. Propensity scores estimating the probability of receiving EDA were used in multivariate correction. The primary outcome was postoperative pneumonia and 30-day mortality.
There were 324 patients (60%) who received EDA in addition to general anesthesia. The incidence of postoperative pneumonia (16% vs. 11%; P = 0.08) and 30-day mortality (9% vs. 5%; P = 0.03) was lower in patients who received EDA. After correction EDA was associated with improved outcome for postoperative pneumonia (OR 0.5; 95% CI: 0.3-0.9; P = 0.03). The strongest preventive effect was seen in patients with the most severe type of COPD.
This study provides evidence that in patients with COPD who are scheduled for major abdominal surgery, epidural analgesia decreases postoperative pulmonary complications. |
| doi_str_mv | 10.1097/ALN.0b013e318224cc5c |
| format | Article |
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This cohort study included 541 consecutive patients with COPD who underwent major abdominal surgery between 1995 and 2007 at a university medical center. Propensity scores estimating the probability of receiving EDA were used in multivariate correction. The primary outcome was postoperative pneumonia and 30-day mortality.
There were 324 patients (60%) who received EDA in addition to general anesthesia. The incidence of postoperative pneumonia (16% vs. 11%; P = 0.08) and 30-day mortality (9% vs. 5%; P = 0.03) was lower in patients who received EDA. After correction EDA was associated with improved outcome for postoperative pneumonia (OR 0.5; 95% CI: 0.3-0.9; P = 0.03). The strongest preventive effect was seen in patients with the most severe type of COPD.
This study provides evidence that in patients with COPD who are scheduled for major abdominal surgery, epidural analgesia decreases postoperative pulmonary complications.</description><identifier>ISSN: 0003-3022</identifier><identifier>EISSN: 1528-1175</identifier><identifier>DOI: 10.1097/ALN.0b013e318224cc5c</identifier><identifier>PMID: 21796055</identifier><identifier>CODEN: ANESAV</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Abdomen - surgery ; Aged ; Analgesia, Epidural ; Anesthesia ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Cohort Studies ; Female ; Humans ; Male ; Medical sciences ; Pneumonia - epidemiology ; Postoperative Complications - epidemiology ; Pulmonary Disease, Chronic Obstructive - complications ; Pulmonary Disease, Chronic Obstructive - mortality ; Retrospective Studies</subject><ispartof>Anesthesiology (Philadelphia), 2011-08, Vol.115 (2), p.315-321</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c382t-48a6a0df37cba10f1861b372d3ae9be9be6ee6ee3004e2d25f9e945960d8cab13</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,27929,27930</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24406845$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21796055$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>VAN LIER, Felix</creatorcontrib><creatorcontrib>VAN DER GEEST, Patrick J</creatorcontrib><creatorcontrib>HOEKS, Sanne E</creatorcontrib><creatorcontrib>VAN GESTEL, Yvette R. B. M</creatorcontrib><creatorcontrib>HOL, Jaap W</creatorcontrib><creatorcontrib>SIN, Don D</creatorcontrib><creatorcontrib>JAN STOLKER, Robert</creatorcontrib><creatorcontrib>POLDERMANS, Don</creatorcontrib><title>Epidural Analgesia Is Associated with Improved Health Outcomes of Surgical Patients with Chronic Obstructive Pulmonary Disease</title><title>Anesthesiology (Philadelphia)</title><addtitle>Anesthesiology</addtitle><description>Patients with chronic obstructive pulmonary disease (COPD) have increased postoperative morbidity and mortality. Epidural analgesia (EDA) improves postoperative outcome but may worsen postoperative lung function. It is unknown whether patients with COPD benefit from EDA. The objective of this study was to determine whether patients with COPD undergoing major abdominal surgery benefit from EDA in addition to general anesthesia.
This cohort study included 541 consecutive patients with COPD who underwent major abdominal surgery between 1995 and 2007 at a university medical center. Propensity scores estimating the probability of receiving EDA were used in multivariate correction. The primary outcome was postoperative pneumonia and 30-day mortality.
There were 324 patients (60%) who received EDA in addition to general anesthesia. The incidence of postoperative pneumonia (16% vs. 11%; P = 0.08) and 30-day mortality (9% vs. 5%; P = 0.03) was lower in patients who received EDA. After correction EDA was associated with improved outcome for postoperative pneumonia (OR 0.5; 95% CI: 0.3-0.9; P = 0.03). The strongest preventive effect was seen in patients with the most severe type of COPD.
This study provides evidence that in patients with COPD who are scheduled for major abdominal surgery, epidural analgesia decreases postoperative pulmonary complications.</description><subject>Abdomen - surgery</subject><subject>Aged</subject><subject>Analgesia, Epidural</subject><subject>Anesthesia</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Pneumonia - epidemiology</subject><subject>Postoperative Complications - epidemiology</subject><subject>Pulmonary Disease, Chronic Obstructive - complications</subject><subject>Pulmonary Disease, Chronic Obstructive - mortality</subject><subject>Retrospective Studies</subject><issn>0003-3022</issn><issn>1528-1175</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkFtr3DAQhUVJabZp_0EJegl5cqqLZcuPyyZtFpZuoO2zGcvjRMGXjUZO6Et_e7XsNoXCwHDgnLl8jH2S4kqKqvy83Hy7Eo2QGrW0SuXOGfeGLaRRNpOyNCdsIYTQmRZKnbL3RI9Jlkbbd-xUybIqhDEL9vtm59s5QM-XI_T3SB74mviSaHIeIrb8xccHvh52YXpO6hahT3o7RzcNSHzq-Pc53HuXJtxB9DhGOkRWD2EavePbhmKYXfTPyO_mfphGCL_4tScEwg_sbQc94cdjP2M_v9z8WN1mm-3X9Wq5yZy2Kma5hQJE2-nSNSBFJ20hG12qVgNWzb4K3JcWIkfVKtNVWOUm_dhaB43UZ-zyMDe98TQjxXrw5LDvYcRpptraBLLQpU3O_OB0YSIK2NW74Id0ci1FvQdfJ_D1_-BT7Py4YG4GbF9Df0knw8XRAJRgdQFG5-mfL89FYXOj_wCst49j</recordid><startdate>20110801</startdate><enddate>20110801</enddate><creator>VAN LIER, Felix</creator><creator>VAN DER GEEST, Patrick J</creator><creator>HOEKS, Sanne E</creator><creator>VAN GESTEL, Yvette R. B. M</creator><creator>HOL, Jaap W</creator><creator>SIN, Don D</creator><creator>JAN STOLKER, Robert</creator><creator>POLDERMANS, Don</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</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>7X8</scope></search><sort><creationdate>20110801</creationdate><title>Epidural Analgesia Is Associated with Improved Health Outcomes of Surgical Patients with Chronic Obstructive Pulmonary Disease</title><author>VAN LIER, Felix ; VAN DER GEEST, Patrick J ; HOEKS, Sanne E ; VAN GESTEL, Yvette R. B. M ; HOL, Jaap W ; SIN, Don D ; JAN STOLKER, Robert ; POLDERMANS, Don</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c382t-48a6a0df37cba10f1861b372d3ae9be9be6ee6ee3004e2d25f9e945960d8cab13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Abdomen - surgery</topic><topic>Aged</topic><topic>Analgesia, Epidural</topic><topic>Anesthesia</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Pneumonia - epidemiology</topic><topic>Postoperative Complications - epidemiology</topic><topic>Pulmonary Disease, Chronic Obstructive - complications</topic><topic>Pulmonary Disease, Chronic Obstructive - mortality</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>VAN LIER, Felix</creatorcontrib><creatorcontrib>VAN DER GEEST, Patrick J</creatorcontrib><creatorcontrib>HOEKS, Sanne E</creatorcontrib><creatorcontrib>VAN GESTEL, Yvette R. B. M</creatorcontrib><creatorcontrib>HOL, Jaap W</creatorcontrib><creatorcontrib>SIN, Don D</creatorcontrib><creatorcontrib>JAN STOLKER, Robert</creatorcontrib><creatorcontrib>POLDERMANS, Don</creatorcontrib><collection>Pascal-Francis</collection><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>Anesthesiology (Philadelphia)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>VAN LIER, Felix</au><au>VAN DER GEEST, Patrick J</au><au>HOEKS, Sanne E</au><au>VAN GESTEL, Yvette R. B. 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The objective of this study was to determine whether patients with COPD undergoing major abdominal surgery benefit from EDA in addition to general anesthesia.
This cohort study included 541 consecutive patients with COPD who underwent major abdominal surgery between 1995 and 2007 at a university medical center. Propensity scores estimating the probability of receiving EDA were used in multivariate correction. The primary outcome was postoperative pneumonia and 30-day mortality.
There were 324 patients (60%) who received EDA in addition to general anesthesia. The incidence of postoperative pneumonia (16% vs. 11%; P = 0.08) and 30-day mortality (9% vs. 5%; P = 0.03) was lower in patients who received EDA. After correction EDA was associated with improved outcome for postoperative pneumonia (OR 0.5; 95% CI: 0.3-0.9; P = 0.03). The strongest preventive effect was seen in patients with the most severe type of COPD.
This study provides evidence that in patients with COPD who are scheduled for major abdominal surgery, epidural analgesia decreases postoperative pulmonary complications.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>21796055</pmid><doi>10.1097/ALN.0b013e318224cc5c</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Abdomen - surgery Aged Analgesia, Epidural Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Cohort Studies Female Humans Male Medical sciences Pneumonia - epidemiology Postoperative Complications - epidemiology Pulmonary Disease, Chronic Obstructive - complications Pulmonary Disease, Chronic Obstructive - mortality Retrospective Studies |
| title | Epidural Analgesia Is Associated with Improved Health Outcomes of Surgical Patients with Chronic Obstructive Pulmonary Disease |
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