Abstract 11804: Improved Recovery Times and Postoperative Outcomes After Cardiac Surgery Done Under Thoracic Epidural Anaesthesia: A Systematic Review, Meta-Analysis, With Trial Sequential Analysis

Abstract

Background: Research on fast-track recovery protocols postulate epidural anaesthesia (TEA) in cardiac surgery contribute to improved postoperative outcomes. However, concerns about TEA’s safety and current equivocal evidence, hinder its widespread usage. We conducted a systematic review and meta-analysis to assess the effects of TEA in cardiac surgery. Methods: We searched four databases for randomised controlled trials (RCTs) assessing the use of TEA against only GA in adults undergoing cardiac surgery, up till 4 June 2022. We conducted random effects meta-analyses (DerSimonian and Laird), evaluated risk of bias using the Cochrane Risk-of-Bias 2 tool, and rated certainty of evidence via the GRADE approach. Primary outcomes were ICU and Hospital length of stay, with other outcomes including postoperative complications. Trial sequential analysis (TSA) was conducted on all outcomes to elicit statistical and clinical benefit. Results: Our meta-analysis included 39 RCTs (1941 TEA patients, 2047 GA patients). TEA significantly reduced ICU LOS (Figure 1: -6.8 hours, 95%-CI: -10.8 to -2.8, p=0.0009), hospital LOS (-0.7 days, 95%-CI: -1.2 to -0.2, p=0.0051), and extubation time (-2.8 hours, 95%-CI: -3.8 to -1.8, p=0.0001). However, there was no significant reduction in mortality. TSA found that the cumulative Z-curve passed the TSA-adjusted boundary for ICU LOS (see below), hospital LOS, and ET, suggesting a clinical benefit. TEA also significantly reduced transfusion requirements, pain scores, delirium, arrhythmia, and pooled pulmonary complications, without additional complications such as epidural hematomas. Conclusions: TEA reduces ICU and hospital lengths of stay, and postoperative complications in patients undergoing cardiac surgery with minimal reported complications. These findings favour the use of TEA in cardiac surgery, and warrants consideration for use in cardiac surgeries worldwide.