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Original research
Differences in the association between epidural analgesia and length of stay by surgery type: an observational study
  1. Anuj B Patel1,
  2. Gerard J Kerins1,
  3. Brian D Sites2,
  4. Chloe Nadine M Duprat1 and
  5. Matthew Davis3,4
  1. 1Dartmouth-Hitchcock Health, Lebanon, New Hampshire, USA
  2. 2Anesthesiology and Orthopaedics, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
  3. 3Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
  4. 4Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA
  1. Correspondence to Dr Brian D Sites, Anesthesiology and Orthopaedics, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA; brian.d.sites{at}gmail.com

Abstract

Introduction Despite a decline in the use of thoracic epidural analgesia related in part to concerns for delayed discharge, it is unknown whether changes in length of stay (LOS) associated with epidural analgesia vary by surgery type. Therefore, we determined the degree to which the association between epidural analgesia (vs no epidural) and LOS differed by surgery type.

Methods We conducted an observational study using data from 1747 patients who had either non-emergent open abdominal, thoracic, or vascular surgery at a single tertiary academic hospital. The primary outcome was hospital LOS and the incidence of a prolonged hospital LOS defined as 21 days or longer. Secondary endpoints included escalation of care, 30-day all-cause readmission, and reason for epidural not being placed. The association between epidural status and dichotomous endpoints was examined using logistic regression.

Results Among the 1747 patients, 85.7% (1499) received epidural analgesia. 78% (1364) underwent abdominal, 11.5% (200) thoracic, and 10.5% (183) vascular surgeries. After adjustment for differences, receiving epidural analgesia (vs no epidural) was associated with a 45% reduction in the likelihood of a prolonged LOS (p<0.05). This relationship varied by surgery type: abdominal (OR 0.42, 95% CI 0.23 to 0.79, p<0.001), vascular (OR 1.66, 95% CI 0.17 to 16.1, p=0.14), and thoracic (OR 1.07, 95% CI 0.20 to 5.70, p=0.93). Among abdominal surgical patients, epidural analgesia was associated with a median decrease in LOS by 1.4 days and a 37% reduction in the likelihood of 30-day readmission (adjusted OR 0.63, 0.41 to 0.97, p<0.05). Among thoracic surgical patients, epidural analgesia was associated with a median increase in LOS by 3.2 days.

Conclusions The relationship between epidural analgesia and LOS appears to be different among different surgical populations.

  • Injections, Spinal
  • Outcome Assessment, Health Care
  • Pain Management
  • Pain, Postoperative

Data availability statement

Data are available upon reasonable request. Data availability would be a function of Dartmouth Health Policy and data license agreements.

https://doi.org/10.1136/rapm-2023-105194

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    Data availability statement

    Data are available upon reasonable request. Data availability would be a function of Dartmouth Health Policy and data license agreements.

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    Footnotes

    • Twitter @sites_brian

    • Contributors All authors have contributed to the study per ICMJE definitions. BS takes full responsibility for the data, conduct of study, access to data, and controlled the decision to publish.

    • 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 Brian Sites is the editor-in-chief of Regional Anesthesia & Pain Medicine Journal. Matthew Davis is the executive editor of Statistics for Regional Anesthesia & Pain Medicine.

    • 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.