National trends in perioperative epidural analgesia use for surgical patients.

Autor: Bongbong DN; School of Medicine, University of California, San Diego, La Jolla, CA, USA., Abdou W; School of Medicine, University of California, San Diego, La Jolla, CA, USA., Said ET; Division of Regional Anesthesia, Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA; Division of Perioperative Informatics, Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA; Division of Biomedical Information, Department of Medicine, University of California, San Diego, La Jolla, CA, USA., Gabriel RA; Division of Regional Anesthesia, Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA; Division of Perioperative Informatics, Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA; Division of Biomedical Information, Department of Medicine, University of California, San Diego, La Jolla, CA, USA. Electronic address: ragabriel@health.ucsd.edu.
Jazyk: angličtina
Zdroj: Journal of clinical anesthesia [J Clin Anesth] 2024 Dec; Vol. 99, pp. 111642. Date of Electronic Publication: 2024 Oct 01.
DOI: 10.1016/j.jclinane.2024.111642
Abstrakt: Study Objective: Newer regional anesthesia techniques and minimally invasive surgeries have yielded decreased postoperative pain scores, potentially leading to decreased need for perioperative epidural analgesia. Limited literature is available on trends in usage rates of epidurals. The objective of this study was to identify trends in perioperative epidural analgesia rates among multiple fields of surgery.
Methods: All patients undergoing general, thoracic, urologic, plastic, vascular, orthopedic, or gynecological surgery in 2014-2020 were included from the National Surgical Quality Improvement Program database of over 700 hospitals in the U.S. and 11 different countries. Annual trends in epidural analgesia for all surgeries and each surgical specialty were assessed by mixed effects multivariable logistic regression. The odds ratios (OR) and 99 % confidence intervals (CI) were reported.
Results: There were 3,111,435 patients from 2014 to 2020 that were included in the final analysis, in which 107,209 (3.4 %) received perioperative epidural analgesia. Among all surgeries combined, epidural use throughout the study period decreased (OR 0.98 per year, 99 % CI 0.97-0.98, P < 0.001). When only analyzing the surgeries with the top 5 most frequent epidural use per specialty, there was no statistically significant trend in epidural utilization (OR 0.99 per year, 99 % CI 0.99-1.00, P = 0.09). However, there was an increasing trend in epidural utilization in general surgery (OR 1.05 per year, 99 % CI 1.03-1.07, P < 0.001) and vascular surgery (OR 1.08 per year, 99 % CI 1.05-1.10, P < 0.001).
Conclusion: Rates of perioperative epidural analgesia use has decreased in recent years overall, however, among surgeries within the general surgery and vascular surgery specialty, utilization has increased for procedures that have the highest rates of usage.
Competing Interests: Declaration of competing interest RG's institution has received funding and/or product for research purposes from Epimed, Infutronix, SPR Therapeutics, Merck, and Precision Genetics. RG is a consultant for Avanos.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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