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Epidural Anesthesia is Associated With Increased Complications in Cystectomy Patients: A NSQIP Analysis

  • Kirtishri Mishra
    Affiliations
    Case Western Reserve University School of Medicine, Cleveland, OH

    University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH

    Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH
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  • Austin Fernstrum
    Correspondence
    Address correspondence to: Austin Fernstrum, M.D., University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Urology Institute, 11100 Euclid Avenue, Lakeside Building Suite 4954, Mailstop LKS 5046, Cleveland, OH 44106.
    Affiliations
    Case Western Reserve University School of Medicine, Cleveland, OH

    University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH

    Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH
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  • Amr Mahran
    Affiliations
    Case Western Reserve University School of Medicine, Cleveland, OH

    University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH
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  • Vasu Sidagam
    Affiliations
    University Hospitals Cleveland Medical Center, Department of Perioperative Medicine, Cleveland, OH
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  • Brittany Adamic
    Affiliations
    University of Chicago Medical Center, Chicago, IL
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  • Anjali Shekar
    Affiliations
    Case Western Reserve University School of Medicine, Cleveland, OH
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  • Adam Calaway
    Affiliations
    Case Western Reserve University School of Medicine, Cleveland, OH

    University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH

    Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH
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  • Carvell Nguyen
    Affiliations
    Case Western Reserve University School of Medicine, Cleveland, OH

    Metro Health Medical Center, Cleveland, OH
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  • Lee Ponsky
    Affiliations
    Case Western Reserve University School of Medicine, Cleveland, OH

    University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH

    Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH
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  • Laura Bukavina
    Affiliations
    Case Western Reserve University School of Medicine, Cleveland, OH

    University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH

    Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH
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Published:January 15, 2020DOI:https://doi.org/10.1016/j.urology.2020.01.002

      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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