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Epidural Anesthesia-Analgesia and Patient Outcomes: A Perspective

DOI: 10.1155/2014/948164

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The use of perioperative epidural anesthesia-analgesia may confer many benefits including superior postoperative analgesia, decreased morbidity, and improvement in patient-centered outcomes. We will review our group’s work on perioperative epidural anesthesia-analgesia on patient outcomes and discuss future research in this area 1. Introduction The use of perioperative epidural anesthesia-analgesia provides superior postoperative analgesia [1–3] versus conventional opioids, is associated with beneficial physiologic effects [4], and has been shown to improve patient-centered outcomes [5]. However, the benefits of perioperative epidural anesthesia-analgesia are not definitive in part due to some of the methodological issues present in available studies. We will review our group’s work on perioperative epidural anesthesia-analgesia on patient outcomes which includes mortality, major morbidity, and patient centered outcomes but not technical failures or complications. We will also discuss future research in this area. 2. Effect on Mortality The overall effect of epidural anesthesia-analgesia on perioperative mortality is controversial. Because of the relatively rare incidence of this endpoint, one option is to utilize a large database which would be able to capture rare outcomes such as death. We have used a 5% nationally random sample of Medicare beneficiaries (1997–2001) to examine the association between the presence or absence of postoperative epidural analgesia and perioperative (7- and 30-day) mortality [6–10]. In our initial analysis [6], we examined several surgical procedures (based on International Statistical Classification of Diseases, Ninth Revision (ICD-9) codes) and divided patients into 2 groups, depending on the presence or absence of postoperative epidural analgesia. Mortality at 7 and 30 days after surgery was examined and multivariate regression analyses incorporating race, gender, age, comorbidities, hospital size, hospital teaching status, and hospital technology status were undertaken. Our first publication using the Medicare claims data found that the presence of epidural analgesia was associated with significantly lower odds of death at 7 days (odds ratio (OR) = 0.52; 95% confidence interval (CI): 0.38–0.73; ) and 30 days (OR = 0.74; 95% CI: 0.63–0.89; ) postoperatively, thus suggesting that postoperative epidural analgesia may contribute to lower odds of death after surgery [6]. Subsequent analyses of the Medicare claims data also revealed that the presence of postoperative epidural analgesia may be associated with lower

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