Effect of postoperative epidural analgesia on morbidity and mortality following surgery in medicare patients

Abstract

Postoperative epidural analgesia may contribute to lower odds of death after surgery.

Correlation of postoperative epidural analgesia on morbidity and mortality after colectomy in Medicare patients

“…The methodology of our current analysis was similar to that of our prior analyses [9,10]. Major morbidity at 7 and 30 days after surgery was obtained from part B for each group based on the presence of the following ICD-9-CM diagnosis codes: acute myocardial infarction (MI), 410. x; with x representing any number from 0 to 9.…”

“…Despite the limitations of database analysis, the acquisition and analysis of a database containing millions of patients would facilitate assessment of rare outcomes such as death and reflect actual morbidity and mortality rates from clinical practice. We previously used administrative databases to examine the effectiveness of postoperative epidural analgesia on morbidity and mortality in Medicare patients undergoing a mix of surgical procedures [9], and we currently have performed a subgroup analysis of this data to specifically examine a relatively high-risk procedure (ie, colectomy) where available RCTs indicate a potential benefit for postoperative epidural analgesia in decreasing morbidity.…”

Effect of postoperative epidural analgesia on morbidity and mortality after lung resection in Medicare patients

“…There were no differences in the adjusted odds ratio, in the incidence of major morbidity between those who received postoperative epidural analgesia or not. The overall rate of postoperative epidural use was relatively high at 50% compared to an overall use rate of approximately 20% [1].…”

“…Some randomized controlled trials (RCTs), meta-analyses, and large database analyses demonstrate a decrease in perioperative morbidity and mortality [1]; however, another investigation has shown no such benefit [2]. The vast majority of these trials have used a randomized, controlled format to determine whether a causal relationship exists between perioperative epidural anesthesia-analgesia and patient outcomes.…”

Evidence-Based Perianesthesia Care: Accelerated Postoperative Recovery Programs

“…21,28 Mortality can be influenced as well; a 5% random sampling of Medicare beneficiaries over a fouryear period revealed that postoperative epidural analgesia may contribute to lower risk of death after surgery. 6 The inflammatory process and pain are directly related to the extent of surgical trauma. 21 Therefore, in an effort to reduce the harmful effects of these phenomena, the use of minimally invasive surgical techniques, such as laparoscopy, whenever feasible is another key concept of fast-track surgery.…”