Does epidural anesthesia affect the outcomes of hepatic resections? Analysis of the ACS NSQIP database

Abstract

Background: The aim of this study is to examine the effect of adjunct epidural anesthesia (ED) on post-hepatectomy outcomes from a national database. Methods: Patients undergoing hepatectomy in the NSQIP targeted file (2014–2016) were identified. Those with INR>1.5, Platelets< 100, bleeding disorders, and adjunct anesthesia (other than epidural) were excluded. Patients with and without EA were matched (1:1) using propensity scores to adjust for baseline differences. Results: Among 9,812 cases, 1,568 (16%) had EA. Of whom 1,434 were matched (1:1) to those without EA. The matched cohort is well-balanced on preoperative characteristics and type of operation (including concomitant resections, ablations and biliary reconstruction). In the case-matched cohort, patients with EA had higher incidence of postoperative renal failure (2.1% vs. 0.98%, p = 0.015), overall morbidity (41.9% vs. 36.5%, p = 0.003) and serious morbidity (24.1% vs. 20.4%, p=0.02) as well as longer hospital stay (median, 6 d vs. 5 d, p < 0.001) and operative time (mean, 257 min vs. 244 min). Postoperative Blood transfusions (17.7% vs. 23.2%, p < 0.001) and pneumonia (2.9% vs. 4.7%, p = 0.015) were less likely with EA. Conclusion: EA is associated with higher overall morbidity and longer hospital stay, but similar hepatectomy-specific complications. The use of EA is also associated with lower incidence of pneumonia and blood transfusions. These findings do not support the routine use of EA for hepatectomy.