The Effect of Regional Anesthesia on Outcomes After Minimally Invasive Ivor Lewis Esophagectomy

Abstract

The objective of the present study was to determine whether regional anesthesia in addition to general anesthesia was associated with improved outcomes compared with general anesthesia alone in minimally invasive Ivor Lewis esophagectomy. Retrospective cohort study. This study examined patients across multiple hospital institutions using the American College of Surgeons National Surgical Quality Improvement Program dataset. Patients who underwent minimally invasive Ivor Lewis esophagectomy were identified and grouped according to general plus regional anesthesia versus general anesthesia alone. Using multivariate logistic regression, outcomes, including 30-day mortality, respiratory complications, infection, blood clots, reintubation, return to the operating room, and length of hospital stay, were examined. Of the 463 patients who underwent minimally invasive Ivor Lewis esophagectomy, 398 met study inclusion criteria. General and regional anesthesia were administered to 108 patients in the study, with the remainder receiving only general anesthesia. Multivariate regression demonstrated no difference in the primary outcome of 30-day mortality (0.93% for regional and general anesthesia, 2.07% for general anesthesia alone [odds ratio 0.49; p = 0.534]). There was no significant difference for any secondary outcome including return to the operating room, failure to wean from the ventilator, reintubation, surgical site infection, pneumonia, renal insufficiency and failure, cardiac arrest, acute myocardial infarction, transfusion, venous thromboembolism, urinary tract infection, length of hospital stay, or total number of complications per patient. Despite potential benefits of regional anesthesia for minimally invasive Ivor Lewis esophagectomy, the present study did not show significant differences in any outcomes between regional and general anesthesia versus general anesthesia alone.