Epidural Analgesia in Laparoscopic Colorectal Surgery A Nationwide Analysis of Use and Outcomes
Epidural Analgesia in Laparoscopic Colorectal Surgery A Nationwide Analysis of Use and Outcomes
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DOI：
10.1001/jamasurg.2013.3186
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发表时间：
2014-02-01
期刊：
影响因子：
16.9
通讯作者：
Pigazzi, Alessio
中科院分区：
文献类型：
--
作者：
Halabi, Wissam J.;Kang, Celeste Y.;Pigazzi, Alessio
腹腔镜结直肠手术中硬膜外镇痛的应用已被证明在控制疼痛方面优于传统镇痛。然而，关于其成本效益及其对术后结果的影响存在争议。结论：在全国范围内，研究硬膜外镇痛在腹腔镜结直肠手术中的应用，并将其结果与传统镇痛的结果进行比较。和良性息肉。列出硬膜外和常规镇痛组患者的人口统计学特征、疾病和手术类型以及医院环境。进行了1 - 4例病例匹配分析，匹配患者人口统计学特征、医院环境、适应症和手术类型。数据来自2002年1月1日至2010年12月31日的全国住院患者样本。主要结果和指标总住院费用、住院时间、死亡率、肺炎、呼吸衰竭、尿路感染、尿潴留、吻合口瘘和术后肠梗阻。硬膜外镇痛4102例（2.14%）。硬膜外更可能用于大型教学医院、癌症病例和直肠手术。在病例匹配分析中，硬膜外镇痛与住院时间延长0.60天（P = 0.003），住院费用增加3732.71美元（P = 0.02），尿路感染发生率增加（比值比= 1.81; P = 0.05）相关。硬膜外镇痛并不影响呼吸衰竭，肺炎，吻合口漏，肠梗阻，或尿潴留的发病率。结论和相关性腹腔镜结直肠手术的围手术期使用硬膜外镇痛是有限的，在美国。虽然硬膜外镇痛似乎是安全的，但它伴随着更高的住院费用，更长的住院时间和更高的尿路感染发生率。
IMPORTANCE The use of epidural analgesia in laparoscopic colorectal surgery has demonstrated superiority over conventional analgesia in controlling pain. Controversy exists, however, regarding its cost-effectiveness and its effect on postoperative outcomes.OBJECTIVES To examine the use of epidural analgesia in laparoscopic colorectal surgery at the national level and to compare its outcomes with those of conventional analgesia.DESIGN, SETTING, AND PARTICIPANTS This is a retrospective review of laparoscopic colorectal cases performed with or without epidural analgesia for cancer, diverticular disease, and benign polyps. Patient demographic characteristics, disease and procedure types, and hospital settings were listed for patients in the epidural and conventional analgesia groups. A 1 to 4 case-matched analysis was performed, matching for patient demographic characteristics, hospital setting, indications, and procedure type. Data were obtained from the Nationwide Inpatient Sample between January 1, 2002, and December 31, 2010.MAIN OUTCOMES AND MEASURES Total hospital charge, length of stay, mortality, pneumonia, respiratory failure, urinary tract infection, urinary retention, anastomotic leak, and postoperative ileus.RESULTS A total of 191 576 laparoscopic colorectal cases were identified during the study period. Epidural analgesia was used in 4102 cases (2.14%). Epidurals were more likely to be used in large teaching hospitals, cancer cases, and rectal operations. On case-matched analysis, epidural analgesia was associated with a longer hospital stay by 0.60 day (P = .003), higher hospital charges by $3732.71 (P = .02), and higher rate of urinary tract infection (odds ratio = 1.81; P = .05). Epidural analgesia did not affect the incidence of respiratory failure, pneumonia, anastomotic leak, ileus, or urinary retention.CONCLUSIONS AND RELEVANCE The perioperative use of epidural analgesia in laparoscopic colorectal surgery is limited in the United States. While epidural analgesia appears to be safe, it comes with higher hospital charges, longer hospital stay, and a higher incidence of urinary tract infections.