Abstract ID: A7

Abstract Title: Effectiveness of Epidural Analgesia In Medicare Patients Undergoing Colectomy

Poster Type: Discussion

ABSTRACT BODY

Introduction:
The effect of postoperative epidural analgesia (vs. systemic analgesia) on mortality following colectomy is unclear. Available randomized controlled trials (RCT) have investigated only a small number of patients and focused on return of gastrointestinal function [1-3]. As such the effect of postoperative epidural analgesia (EA) on major morbidity and mortality is uncertain.
Materials and Methods:
A 5% nationally random sample of Medicare beneficiaries from 1997-2001 was analyzed to identify patients undergoing partial excision of the large intestine (ICD-9 codes 45.73 and 45.76). Patients were divided into two groups depending on the presence or absence of postoperative EA based on the presence of the CPT code 01996. Emergency surgical cases were excluded. Baseline characteristics (demographic and cormorbidities [4]) were compared. The rate of major morbidity (acute myocardial infarction, angina, cardiac dysrhythmias, heart failure, pneumonia, pulmonary edema, respiratory failure, deep venous thrombosis, pulmonary embolism, sepsis, acute renal failure, somnolence, acute cerebrovascular event, transient organic syndrome, and paralytic ileus) and death at 7 and 30 days following the procedure were compared. Multivariate regression analysis incorporating race, gender, age, comorbidities, hospital size, hospital teaching status, and hospital technology status was performed to determine if the presence of postoperative (EA) had an independent effect on mortality or major morbidity.
Results:
Multivariate regression analysis revealed that there was no difference between the groups with regard to overall major morbidity; however, the presence of epidural analgesia was associated with a significantly lower odds of death at 7 days (OR = 0.35 [95% CI: 0.21-0.59], p < 0.0001) and 30 days (OR = 0.54 [95% CI: 0.42-0.70], < 0.0001) after surgery.
Discussion:
Although there are many physiologic benefits of epidural analgesia [5,6], the use of postoperative EA was not associated a lower incidence major morbidity in Medicare patients undergoing elective colectomy. However, the presence of epidural analgesia (vs. no epidural) was associated with significantly lower odds of death at 7 and 30 days after surgery, which is similar to that found in a meta-analysis of RCT [7]. It is not clear from the current analysis how epidural analgesia may decrease postoperative morbidity as there were no differences between the groups with regard to major morbidities although there are limitations in coding of morbidities in this type of data [8].
References:
1. Liu SS et al. Anesthesiology 1995;83:757-765.
2. Jorgensen H et al Cochrane Database Syst Rev 2000;(4):CD001893.
3. Steinbrook RA. Anesth Analg 1998;86:837-844.
4. Elixhauser A et al. Med Care 1998;36:8-27.
5. Wu CL et al. Anesth Analg 2000;91:1232-1242.
6. Liu S et al. Anesthesiology 1995;82:1474-1506.
7. Rodgers A et al. BMJ 2000;321:1493-1496.
A7. Wu CL et al. Reg Anesth Pain Med 2003;28:271-278.

ATTACHED FILES

A7_table.doc

Reg Anesth Pain Med 2004; 29(2):A7