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  • Association of thoracic epidural analgesia and hospital length of stay for patients undergoing thoracotomy: a retrospective cohort analysis

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Regional anesthesia and acute pain
Association of thoracic epidural analgesia and hospital length of stay for patients undergoing thoracotomy: a retrospective cohort analysis
  1. Michael Armaneous1,
  2. Austin L Du2,
  3. Rodney A Gabriel2 and
  4. Engy T Said2
  1. 1 Department of Anesthesiology, Riverside University Health System, Moreno Valley, CA, USA
  2. 2 Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
  1. Correspondence to Dr Rodney A Gabriel; ragabriel{at}health.ucsd.edu

Abstract

Introduction Regional anesthesia has been shown to be efficacious for analgesia in patients who underwent thoracotomies. The objective of this study was to analyze the association of epidurals and peripheral regional anesthesia with time to hospital discharge for these patients.

Methods This was a retrospective cohort study using National Surgical Quality Improvement Program dataset from 2014 to 2020. Propensity-matched cohorts were assembled based on use of regional anesthesia, peripheral regional anesthesia, or epidural. Fine-Gray competing risk regressions were used to explore the association between regional anesthesia use and rate of discharge. The subdistribution hazard ratio (HR) represented relative discharge rates, and in-hospital death was a competing event. A sensitivity analysis was subsequently performed in which patients with American Society of Anesthesiologists score ≥4 were removed.

Results There were 4350 patients included in this analysis, in which 472 (10.8%) received a peripheral regional anesthesia nerve block and 565 (13.0%) received thoracic epidural analgesia. The subdistribution HR for rate of discharge in the epidural versus non-epidural cohort was 1.09 (95% CI 1.01 to 1.18), thus epidurals were associated with an increased rate of discharge over time. However, this benefit was no longer apparent with the sensitivity analysis. The subdistribution HR for rate of discharge in the peripheral regional anesthesia versus no regional anesthesia cohort was 1.26 (95% CI 1.15 to 1.39), thus peripheral regional anesthesia was associated with an increased rate of discharge over time. This benefit remained even with the sensitivity analysis.

Conclusions Thoracic epidural use when compared with no regional anesthesia was associated with decreased length of stay following thoracotomy in our primary analysis. The difference was no longer apparent with the sensitivity analysis. Peripheral regional anesthesia was associated with decreased length of stay even after sensitivity analysis.

  • Pain Management
  • Nerve Block
  • Outcome Assessment, Health Care
  • REGIONAL ANESTHESIA

Data availability statement

Data may be obtained from a third party and are not publicly available. Data may be accessed via National Surgical Quality Improvement Program.

https://doi.org/10.1136/rapm-2023-104611

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Data may be accessed via National Surgical Quality Improvement Program.

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    Footnotes

    • Contributors MA is responsible for the study design, analysis and interpretation of data, and drafting the article. ALD is responsible for the study design, analysis and interpretation of data and drafting the article. RG is responsible for the study design, analysis and interpretation of data and drafting the article. ETS is responsible for interpretation of data and drafting the article. RG is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests The University of California has received funding and product for other research projects from Epimed International (Farmers Branch, TX); Infutronics (Natick, MA); Precision Genetics (Greenville County, SC); and SPR Therapeutics (Cleveland, OH) for the following author: RG. The University of California San Diego is a consultant for Avanos (Alpharetta, GA), in which RG represents.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.