Post-Pancreaticoduodenectomy Outcomes and Epidural Analgesia

A 5-year Single-Institution Experience

Rachel E. Simpson, Mitchell L. Fennerty, Cameron L. Colgate, E. Molly Kilbane, Eugene P. Ceppa, Michael House, Nicholas Zyromski, Attila Nakeeb, C. Schmidt

Research output: Contribution to journalArticle

Abstract

Background: Optimal pain control post pancreaticoduodenectomy is a challenge. Epidural analgesia (EDA) is used increasingly, despite inherent risks and unclear effects on outcomes. Methods: All pancreaticoduodenectomies (PDs) performed from January 2013 through December 2017 were included. Clinical parameters were obtained from a retrospective review of a prospective clinical database, the American College of Surgeons NSQIP prospective institutional database, and medical record review. Chi-square, Fisher's exact test, and independent-samples t-tests were used for univariable analyses. Multivariable regression was performed. Results: Six hundred and seventy-one consecutive PDs from a single institution were included (429 EDA, 242 non-EDA). On univariable analysis, EDA patients experienced significantly less wound disruption (0.2% vs 2.1%), unplanned intubation (3.0% vs 7.9%), pulmonary embolism (0.5% vs 2.5%), mechanical ventilation longer than 48 hours (2.1% vs 7.9%), septic shock (2.6% vs 5.8%), and lower pain scores. On multivariable regression (accounting for baseline group differences (ie sex, hypertension, preoperative transfusion, laboratory results, approach, and pancreatic duct size), EDA was associated with less superficial wound infections (odds ratio [OR] 0.34; 95% CI 0.14 to 0.83; p = 0.017), unplanned intubations (OR 0.36; 95% CI 0.14 to 0.88; p = 0.024), mechanical ventilation longer than 48 hours (OR 0.22; 95% CI 0.08 to 0.62; p = 0.004), and septic shock (OR 0.39; 95% CI 0.15 to 1.00; p = 0.050). Epidural analgesia improved pain scores post-PD days 1 to 3 (p < 0.001). No differences were seen in cardiac or renal complications; pancreatic fistula (B+C) or delayed gastric emptying, 30-/90-day mortality, length of stay, readmission, discharge destination, or unplanned reoperation. Conclusions: Based on the largest single-institution series published to date, our data support the use of EDA for optimization of pain control. More importantly, our data document that EDA improved infectious and pulmonary complications significantly.

Original languageEnglish (US)
Pages (from-to)453-462
Number of pages10
JournalJournal of the American College of Surgeons
Volume228
Issue number4
DOIs
StatePublished - Apr 1 2019

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Pancreaticoduodenectomy
Epidural Analgesia
Odds Ratio
Pain
Septic Shock
Artificial Respiration
Intubation
Databases
Pancreatic Fistula
Pancreatic Ducts
Gastric Emptying
Wound Infection
Pulmonary Embolism
Reoperation
Sex Characteristics
Analgesia
Medical Records
Length of Stay
Hypertension
Kidney

ASJC Scopus subject areas

  • Surgery

Cite this

Post-Pancreaticoduodenectomy Outcomes and Epidural Analgesia : A 5-year Single-Institution Experience. / Simpson, Rachel E.; Fennerty, Mitchell L.; Colgate, Cameron L.; Kilbane, E. Molly; Ceppa, Eugene P.; House, Michael; Zyromski, Nicholas; Nakeeb, Attila; Schmidt, C.

In: Journal of the American College of Surgeons, Vol. 228, No. 4, 01.04.2019, p. 453-462.

Research output: Contribution to journalArticle

Simpson, Rachel E. ; Fennerty, Mitchell L. ; Colgate, Cameron L. ; Kilbane, E. Molly ; Ceppa, Eugene P. ; House, Michael ; Zyromski, Nicholas ; Nakeeb, Attila ; Schmidt, C. / Post-Pancreaticoduodenectomy Outcomes and Epidural Analgesia : A 5-year Single-Institution Experience. In: Journal of the American College of Surgeons. 2019 ; Vol. 228, No. 4. pp. 453-462.
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AU - Kilbane, E. Molly

AU - Ceppa, Eugene P.

AU - House, Michael

AU - Zyromski, Nicholas

AU - Nakeeb, Attila

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