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Use and Outcomes of Epidural Analgesia in Upper Gastrointestinal Tract Cancer Resections. | LitMetric

AI Article Synopsis

  • Epidural analgesia (EA) is being explored as a pain relief option for patients undergoing surgery for esophageal and gastric cancers, but its impact on recovery outcomes is not well understood.
  • A study analyzed data from the National Surgical Quality Improvement Program (NSQIP) focusing on patients who had esophagectomies and gastrectomies between 2014 and 2017, finding stable trends in EA usage over time.
  • Results indicated that EA usage was linked to higher rates of blood transfusions after esophagectomies and longer hospital stays for gastrectomies, suggesting the need for further research on its benefits and risks in this patient group.*

Article Abstract

Background: Epidural analgesia (EA) is an appealing adjunct for esophageal and gastric cancer patients. It remains unclear whether EA usage affects postoperative outcomes. There are no national data on the trends of EA utilization for these procedures. This study aims to use the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) to study the utilization and outcomes of EA in open upper GI tract cancer resections.

Materials And Methods: A retrospective review of NSQIP was performed for patients undergoing open elective esophagectomies and gastrectomies for nonmetastatic cancer between 2014 and 2017. An Armitage trend test was performed. The population was propensity matched and assessed.

Results: There were 4802 esophagectomies performed. Twenty-nine percent of patients received EA. Of 2599 gastrectomies, 18% of patients received EA. The recent trends of EA use for esophagectomies (EA range [26.9%, 30.3%] P = 0.6535) and gastrectomies (EA [16.9%, 18.4%], P = 0.7797) remain stable. Propensity matching was performed, and the groups with and without EA were compared. For esophagectomies, EA was associated with blood transfusions (EA 14% versus No EA 10.8%, P = 0.0156). For gastrectomies, EA was associated with longer length of stay (LOS) (EA median [IQR] 8 [7,11] versus No EA 7 [6,11], P = 0.0002).

Conclusions: Despite the current opioid epidemic, the recent trends of EA for esophageal and gastric cancer patients remain stable. EA was associated with blood transfusions for esophagectomies and with a longer LOS for gastrectomies. Therefore, EA should be carefully considered, and its analgesic efficacy in this population should be investigated closely in future studies.

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Source
http://dx.doi.org/10.1016/j.jss.2020.08.018DOI Listing

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