Epidural Anesthesia in Liver Surgery-A Propensity Score-Matched Analysis

被引:5
|
作者
Knaak, Cornelia [1 ,2 ,3 ,4 ]
Spies, Claudia [1 ,2 ,3 ,4 ]
Schneider, Alice [2 ,3 ,4 ,5 ,6 ]
Jara, Maximilian [7 ,8 ]
Vorderwuelbecke, Gerald [1 ,2 ,3 ,4 ]
Kuhlmann, Anna Dorothea [1 ,2 ,3 ,4 ]
von Haefen, Clarissa [1 ,2 ,3 ,4 ]
Lachmann, Gunnar [1 ,2 ,3 ,4 ,6 ]
Schulte, Erika [1 ,2 ,3 ,4 ]
机构
[1] Charite Univ Med Berlin, Dept Anesthesiol & Operat Intens Care Med CCM, CVK, Augustenburger Pl 1, D-13353 Berlin, Germany
[2] Free Univ Berlin, Augustenburger Pl 1, D-13353 Berlin, Germany
[3] Humboldt Univ, Augustenburger Pl 1, D-13353 Berlin, Germany
[4] Berlin Inst Hlth, Augustenburger Pl 1, D-13353 Berlin, Germany
[5] Charite Univ Med Berlin, Inst Biometry & Clin Epidemiol, Berlin, Germany
[6] Berlin Inst Hlth BIH, Berlin, Germany
[7] Campus Charite Mitte, Dept Surg, Berlin, Germany
[8] Campus Virchow Klinikum, Berlin, Germany
关键词
Epidural Anesthesia; Liver Resection; PHYDELIO Trial; Postoperative Coagulopathy; Postoperative Pain; Postoperative Outcome; COAGULATION PROFILE; HEPATIC RESECTION; RISK-FACTORS; ANALGESIA; MORBIDITY; PAIN; COMPLICATIONS; HEPATECTOMY; DISORDERS; MORTALITY;
D O I
10.1093/pm/pnaa130
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Objective. To assess the effects of epidural anesthesia (EA) on patients who underwent liver resection. Design. Secondary analysis of a prospective randomized controlled trial. Setting. This single-center study was conducted at an academic medical center. Methods. A subset of 110 1:1 propensity score-matched patients who underwent liver resection with and without EA were analyzed. Outcome measures were pain intensity >= 5 on a numeric rating scale (NRS) at rest and during movement on postoperative days 1-5, analyzed with logistic mixed-effects models, and postoperative complications according to the Clavien-Dindo classification, length of hospital stay (LOS), and one-year survival. One-year survival in the matched cohorts was compared using a frailty model. Results. EA patients were less likely to experience NRS >= 5 at rest (odds ratio = 0.06, 95% confidence interval [CI] = 0.01 to 0.28, P<0.001). These findings were independent of age, sex, Charlson comorbidity index, baseline NRS, and surgical approach (open vs laparoscopic). The number and severity of postoperative complications and LOS were comparable between groups (P = 0.258, P>0.999, and P = 0.467, respectively). Reduced mortality rates were seen in the EA group one year after surgery (9.1% vs 30.9%, hazard ratio = 0.32, 95% CI = 0.11 to 0.90, P = 0.031). No EA-related adverse events occurred. Earlier recovery of bowel function was seen in EA patients. Conclusions. Patients with EA had better postoperative pain control and required fewer systemic opioids. Postoperative complications and LOS did not differ, although one-year survival was significantly improved in patients with EA. EA applied in liver surgery was effective and safe.
引用
收藏
页码:2650 / 2660
页数:11
相关论文
共 50 条
  • [1] Opioid-Free Anesthesia in Bariatric Surgery: a Propensity Score-Matched Analysis
    Torre, Alessandro
    Marengo, Michele
    Ledingham, Nicola S.
    Ajani, Costanza
    Volonte, Francesco
    Garofalo, Fabio
    Mongelli, Francesco
    [J]. OBESITY SURGERY, 2022, 32 (05) : 1673 - 1680
  • [2] Bariatric Surgery and Hepatocellular Carcinoma: a Propensity Score-Matched Analysis
    Njei, Basile
    McCarty, Thomas R.
    Sharma, Prabin
    Lange, Andrew
    Najafian, Nilofar
    Ngu, Julius N.
    Ngomba, Valmy E.
    Echouffo-Tcheugui, Justin B.
    [J]. OBESITY SURGERY, 2018, 28 (12) : 3880 - 3889
  • [3] Liver Transplantation for Intrahepatic Cholangiocarcinoma: A Propensity Score-Matched Analysis
    Liu, Kang
    Lyu, Yi
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2023, 237 (05) : S294 - S294
  • [4] Bariatric Surgery and Hepatocellular Carcinoma: a Propensity Score-Matched Analysis
    Basile Njei
    Thomas R. McCarty
    Prabin Sharma
    Andrew Lange
    Nilofar Najafian
    Julius N. Ngu
    Valmy E. Ngomba
    Justin B. Echouffo-Tcheugui
    [J]. Obesity Surgery, 2018, 28 : 3880 - 3889
  • [5] Liver transplantation for intrahepatic cholangiocarcinoma: a propensity score-matched analysis
    Gaobo Huang
    Weilun Song
    Yanchao Zhang
    Jiawei Yu
    Yi Lv
    Kang Liu
    [J]. Scientific Reports, 13
  • [6] Liver transplantation for intrahepatic cholangiocarcinoma: a propensity score-matched analysis
    Huang, Gaobo
    Song, Weilun
    Zhang, Yanchao
    Yu, Jiawei
    Lv, Yi
    Liu, Kang
    [J]. SCIENTIFIC REPORTS, 2023, 13 (01)
  • [7] Long Term Outcome of Postoperative Atrial Fibrillation After Cardiac Surgery-A Propensity Score-Matched Cohort Analysis
    Hsu, Jung-Chi
    Huang, Chen-Yu
    Chuang, Shu-Lin
    Yu, Hsu-Yu
    Chen, Yih-Sharng
    Wang, Chih-Hsien
    Lin, Lian-Yu
    [J]. FRONTIERS IN CARDIOVASCULAR MEDICINE, 2021, 8
  • [8] A Propensity Score-Matched Analysis for Non-Intubated Thoracic Surgery
    Lan, Lan
    Cen, Yanyi
    Zhang, Canzhou
    Qiu, Yuan
    Ouyang, Baoyi
    [J]. MEDICAL SCIENCE MONITOR, 2018, 24 : 8081 - 8087
  • [9] Surgery versus no surgery in stage IV gallbladder carcinoma: A propensity score-matched analysis
    Nekarakanti, Phani
    Sugumaran, K.
    Nag, Hirdaya
    [J]. TURKISH JOURNAL OF SURGERY, 2023, 39 (02) : 153 - 161
  • [10] Costs of Robotic and Laparoscopic Bariatric Surgery: A Retrospective Propensity Score-matched Analysis
    Senatore, Anna M.
    Mongelli, Francesco
    Mion, Federico U.
    Lucchelli, Massimo
    Garofalo, Fabio
    [J]. OBESITY SURGERY, 2024,