Abstract
Objective
To identify differences in short-term outcomes and readmission rates in cystectomy
patients managed with general anesthesia compared to those undergoing general anesthesia
and adjuvant epidural anesthesia.
Methods
Utilizing the National Surgical Quality Inpatient Program database, patients who underwent
a cystectomy with ileal conduit between 2014 and 2017 were included. Patients were
further subdivided based on additional anesthesia modality; general anesthesia vs
general anesthesia plus epidural anesthesia. Propensity score-matching was used to
adjust for baseline differences between cohorts using 1:1 caliper width of 0.15 for
the propensity score through the nearest neighbor. Stepwise multivariable logistic
regression was used to identify preoperative and intraoperative predictors associated
with 30-day procedure related readmission, complications, and length of stay.
Results
About 2956 patients met our inclusion and exclusion criteria and eligible for propensity
score matching. Compared to general anesthesia, adjuvant epidural anesthesia showed
an increased odds of procedure related complications (adjusted Odds Ratio (aOR): 1.264,
95% CI: 1.019-1.567, P = .033). There was an increased trend for development of pulmonary emboli (13 [1.8%]
vs 4 [0.5%], P = .051) in the adjuvant epidural cohort. Combined general with epidural anesthesia
demonstrated no difference in length of stay, readmission, or reoperation rate in
comparison to general anesthesia alone.
Conclusion
Cystectomy patients who underwent general anesthesia plus epidural anesthesia demonstrated
a higher percentage of any procedural related complication without change in postoperative
stay, reoperation rate, or readmission rate compared to patients undergoing general
anesthesia alone.
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References
- Association between preoperative albumin levels and length of stay after radical cystectomy.J Urol. 2017; 198: 1039-1045
- Transversus abdominis plane blockade as part of a multimodal postoperative analgesia plan in patients undergoing radical cystectomy.Bladder Cancer. 2018; 4: 161-167
- Health related quality of life in patients treated with radical cystectomy and urinary diversion for urothelial carcinoma of the bladder: development and validation of a new disease specific questionnaire.J Urol. 2003; 170: 1926-1930
- Complications of radical cystectomy for nonmuscle invasive disease: comparison with muscle invasive disease.J Urol. 2003; 169: 101-104
- Short-term morbidity and mortality of Indiana pouch, ileal conduit, and neobladder urinary diversion following radical cystectomy.Urol Oncol. 2014; 32: 1151-1157
- Spinal analgesia for laparoscopic colonic resection using an enhanced recovery after surgery programme: better analgesia, but no benefits on postoperative recovery: a randomized controlled trial.Br J Anaesth. 2012; 108: 850-856
- The role of the anesthesiologist in fast-track surgery: from multimodal analgesia to perioperative medical care.Anesth Analg. 2007; 104 (table of contents): 1380-1396
- Efficacy of patient-controlled versus conventional analgesia for postoperative pain.Clin Pharm. 1985; 4: 48-52
- Continuous spinal anaesthesia for laparotomy.Curr Anaesth Crit Care. 2009; 20: 60-64
- Continuous spinal anesthesia for elderly patients with cardiomyopathy undergoing lower abdominal surgeries.Egypt J Anaesth. 2016; 32535540
- Anesthesia type and perioperative outcome: open colectomies in the United States.J Surg Res. 2015; 193: 684-692
- Patient safety and comparative effectiveness of anesthetic technique in open lung resections.Chest. 2015; 148: 722-730
- Perioperative comparative effectiveness of anesthetic technique in orthopedic patients.Anesthesiology. 2013; 118: 1046-1058
- Do intraoperative analgesics influence oncological outcomes after radical prostatectomy for prostate cancer?.Eur J Anaesthesiol. 2011; 28: 830-835
- Regional anaesthesia and analgesia: relationship to cancer recurrence and survival.Br J Anaesth. 2015; 115: ii34-ii45
- Effects of regional versus general anesthesia on outcomes after total hip arthroplasty: a retrospective propensity-matched cohort study.J Bone Joint Surg Am. 2015; 97: 186-193
- Propensity score-matched comparison of postoperative adverse outcomes between geriatric patients given a general or a neuraxial anesthetic for hip surgery: a population-based study.Anesthesiology. 2015; 123: 136-147
- Intravenous lidocaine versus thoracic epidural analgesia: a randomized controlled trial in patients undergoing laparoscopic colorectal surgery using an enhanced recovery program.Reg Anesth Pain Med. 2011; 36: 241-248
- Hospitalization for partial nephrectomy was not associated with intrathecal opioid analgesia: retrospective analysis.Saudi J Anaesth. 2014; 8: 517-522
- Is there a measurable association of epidural use at cystectomy and postoperative outcomes? A population-based study.Can Urol Assoc J. 2016; 10: 321-327
- Fast-track surgery and technical nuances to reduce complications after radical cystectomy and intestinal urinary diversion with the modified Indiana pouch.Surg Oncol. 2012; 21: 191-195
- Spinal analgesia improves surgical outcome after open nephrectomy for renal cell carcinoma: a randomized controlled study.Scand J Urol. 2017; 51: 277-281
- Race and postoperative complications following urologic cancer surgery: an ACS-NSQIP analysis.Urol Oncol. 2017; 35 (670.e671-670.e676)
- Differences in short-term complications between spinal and general anesthesia for primary total knee arthroplasty.J Bone Joint Surg Am. 2013; 95: 193-199
- Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review.Can J Surg. 2008; 51: 428-436
Bukavina L Mishra K, Mahran A, et al. Gender disparity in cystectomy postoperative outcomes: propensity score analysis of the NSQIP database. Eur Urol Oncol. In.
- Superfluous hospital expenditure associated with unnecessary renal cyst surveillance.Urol Pract. 2019; 7: 1-6
- The cost-effectiveness of epidural, patient-controlled intravenous opioid analgesia, or transversus abdominis plane infiltration with liposomal bupivacaine for postoperative pain management.J Clin Anesth. 2019; 53: 56-63
- Comparison of perioperative outcomes for epidural versus intravenous patient-controlled analgeasia after radical cystectomy.Reg Anesth Pain Med. 2015; 40: 239-244
Article info
Publication history
Published online: January 15, 2020
Accepted:
January 6,
2020
Received:
October 9,
2019
Footnotes
Funding: None.
Disclosures: None.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
