Association of thoracic epidural analgesia and hospital length of stay for patients undergoing thoracotomy: a retrospective cohort analysis.

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Regional Anesthesia and Pain Medicine Pub Date : 2024-11-04 DOI:10.1136/rapm-2023-104611

Michael Armaneous, Austin L Du, Rodney A Gabriel, Engy T Said

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引用次数: 0

Abstract

Introduction: Regional anesthesia has been shown to be efficacious for analgesia in patients who underwent thoracotomies. The objective of this study was to analyze the association of epidurals and peripheral regional anesthesia with time to hospital discharge for these patients.

Methods: This was a retrospective cohort study using National Surgical Quality Improvement Program dataset from 2014 to 2020. Propensity-matched cohorts were assembled based on use of regional anesthesia, peripheral regional anesthesia, or epidural. Fine-Gray competing risk regressions were used to explore the association between regional anesthesia use and rate of discharge. The subdistribution hazard ratio (HR) represented relative discharge rates, and in-hospital death was a competing event. A sensitivity analysis was subsequently performed in which patients with American Society of Anesthesiologists score ≥4 were removed.

Results: There were 4350 patients included in this analysis, in which 472 (10.8%) received a peripheral regional anesthesia nerve block and 565 (13.0%) received thoracic epidural analgesia. The subdistribution HR for rate of discharge in the epidural versus non-epidural cohort was 1.09 (95% CI 1.01 to 1.18), thus epidurals were associated with an increased rate of discharge over time. However, this benefit was no longer apparent with the sensitivity analysis. The subdistribution HR for rate of discharge in the peripheral regional anesthesia versus no regional anesthesia cohort was 1.26 (95% CI 1.15 to 1.39), thus peripheral regional anesthesia was associated with an increased rate of discharge over time. This benefit remained even with the sensitivity analysis.

Conclusions: Thoracic epidural use when compared with no regional anesthesia was associated with decreased length of stay following thoracotomy in our primary analysis. The difference was no longer apparent with the sensitivity analysis. Peripheral regional anesthesia was associated with decreased length of stay even after sensitivity analysis.

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开胸手术患者胸外硬膜外镇痛与住院时间的相关性：一项回顾性队列分析。

引言：区域麻醉已被证明对开胸手术患者的镇痛有效。本研究的目的是分析硬膜外和周围区域麻醉与这些患者出院时间的关系。方法：这是一项使用2014年至2020年国家外科质量改进计划数据集的回顾性队列研究。根据区域麻醉、外周区域麻醉或硬膜外麻醉的使用情况，组装倾向匹配的队列。采用Fine-Gray竞争风险回归法探讨区域麻醉使用与出院率之间的关系。次分布危险比（HR）代表相对出院率，住院死亡是一个竞争事件。随后进行了敏感性分析，其中美国麻醉师学会评分≥4的患者被排除。结果：纳入本分析的患者有4350例，其中472例（10.8%）接受了周围区域麻醉神经阻滞，565例（13.0%）接受胸外硬膜外镇痛。硬膜外与非硬膜外队列中出院率的亚分布HR为1.09（95%CI 1.01至1.18），因此硬膜外与随时间增加的出院率相关。然而，在敏感性分析中，这种益处不再明显。外周区域麻醉与非区域麻醉队列中出院率的亚分布HR为1.26（95%CI 1.15至1.39），因此外周区域麻与出院率随时间增加有关。即使进行了敏感性分析，这种益处仍然存在。结论：在我们的初步分析中，与不使用区域麻醉相比，使用胸外硬膜外麻醉与开胸术后住院时间缩短有关。在敏感性分析中，差异不再明显。即使在敏感性分析后，周围区域麻醉也与住院时间缩短有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Regional Anesthesia and Pain Medicine 医学-麻醉学

CiteScore

8.50

自引率

11.80%

发文量

175

审稿时长

6-12 weeks

期刊介绍： Regional Anesthesia & Pain Medicine, the official publication of the American Society of Regional Anesthesia and Pain Medicine (ASRA), is a monthly journal that publishes peer-reviewed scientific and clinical studies to advance the understanding and clinical application of regional techniques for surgical anesthesia and postoperative analgesia. Coverage includes intraoperative regional techniques, perioperative pain, chronic pain, obstetric anesthesia, pediatric anesthesia, outcome studies, and complications. Published for over thirty years, this respected journal also serves as the official publication of the European Society of Regional Anaesthesia and Pain Therapy (ESRA), the Asian and Oceanic Society of Regional Anesthesia (AOSRA), the Latin American Society of Regional Anesthesia (LASRA), the African Society for Regional Anesthesia (AFSRA), and the Academy of Regional Anaesthesia of India (AORA).