Abstract ID: A8

Abstract Title: Effect of Epidural Analgesia on Postoperative Mortality in Medicare Patients Undergoing Lung Resection

Poster Type: Discussion


ABSTRACT BODY

Introduction:
Although available randomized controlled trials (RCT) and meta-analyses of trials suggest that perioperative use of epidural analgesia (EA) will decrease some morbidity (e.g., respiratory failure, pneumonia)[1-3], the effect of EA (vs. systemic analgesia) on a less frequent outcome such as death following partial lung resection is unclear.
Materials and Methods:
A 5% nationally random sample of Medicare beneficiaries from 1997-2001 was analyzed to identify patients undergoing segmental excision of the lung/lobectomy (ICD-9 codes 32.3 and 32.4). 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 and patient undergoing pneumonectomy 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 = 0.39 [95% CI: 0.19-0.80], p = 0.001) and 30 days (OR = 0.53 [95% CI: 0.35-0.78], p = 0.002) after surgery.
Discussion:
The use of postoperative EA was not associated a lower incidence major morbidity in Medicare patients undergoing elective segmental excision of the lung but the presence of epidural analgesia (vs. no epidural) was associated with a significantly lower odds of death at 7 and 30 days after surgery. There are many physiologic benefits of epidural analgesia [5,6] and RCTs [1-3] demonstrate that EA will decrease the incidence of respiratory failure and pneumonia; however, the current analysis does not show a decrease in these complications. There are limitations to using database analysis to examine this issue [7] which may explain some of these discrepancies (i.e., no decrease in morbidity but an a decrease in mortality with EA).
References:
1. Rodgers A et al. BMJ 2000;321:1493-1496.
2. Ballantyne JC et al. Anesth Analg 1998;86:598-612.
3. Rigg JR et al. Lancet 2000;359:1276-1282.
4. Elixhauser A et al. Med Care 1998;36:8-27.
5. Liu S et al. Anesthesiology 1995;82:1474-1506.
6. Wu CL et al. Anesth Analg 2000;91:1232-1242.
7. Wu CL et al. Reg Anesth Pain Med 2003;28:271-278.









ATTACHED FILES

A8_ASRA-01996-resection of lung-table.doc





Reg Anesth Pain Med 2004; 29(2):A8