Epidural anesthesia for post-operative pain is associated with a higher incidence of complications following open ventral hernia repair. Surg Endosc 2020 Aug;34(8):3527-3532
Date
09/27/2019Pubmed ID
31555915DOI
10.1007/s00464-019-07136-8Scopus ID
2-s2.0-85074052883 (requires institutional sign-in at Scopus site) 5 CitationsAbstract
INTRODUCTION: Ventral/incisional hernia repair is a common procedure. Epidural anesthesia for post-operative pain control has been used to attempt to limit opioids. The complications associated with epidural anesthesia are starting to be recognized in open ventral hernia repair patients.
METHODS: Data were abstracted from the National Surgical Quality Improvement Program (NSQIP) participant use data file for 2015. Adult patients with an open ventral hernia repair were identified. In an effort to identify complex hernias, patients who required the implantation of mesh and remained inpatient for 2 or more days were included. Patients with epidural anesthesia and general anesthesia (epidural group) were compared to those with general anesthesia alone (non-epidural). Descriptive statistics and complications were recorded and compared.
RESULTS: A total of 1943 patients met inclusion criteria: 1009 patients (51.9%) in the non-epidural group and 934 (48.1%) in the epidural group. There were fewer clean cases in the epidural group (63.2%) than the non-epidural group (68.8%, p = 0.007). Otherwise, there was no difference in gender, age, body mass index, American Society of Anesthesiologists physical status, and current smoking status. There were more pulmonary emboli in the epidural group (1.39%) compared to the non-epidural group (0.50%, p = 0.04). Urinary tract infection was also significantly higher in the epidural group (3.10%) compared to the non-epidural group (1.59%, p = 0.03). Transfusions were also administered to more of the epidural patients (5.14%) compared to non-epidural patients (2.78%, p = 0.007). The rates of other post-operative complications were not statistically significant between the two groups. Total length of stay in the hospital was also greater in the epidural group (6.7 vs. 5.0 days, p < 0.0001).
CONCLUSIONS: This is an association with the use of epidural anesthesia in open ventral hernia repairs and an increased incidence of pulmonary emboli, transfusions, and urinary tract infections, as well as an increased length of stay.
Author List
Zhou SL, Helm MC, Goldblatt MIAuthor
Matthew I. Goldblatt MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Anesthesia, Epidural
Anesthesia, General
Body Mass Index
Databases, Factual
Female
Hernia, Ventral
Herniorrhaphy
Humans
Incidence
Male
Middle Aged
Pain, Postoperative
Postoperative Complications
Pulmonary Embolism
United States
