27 - Freie Mitteilung
15. Mai 2019, 15:30 - 17:00, Bellavista 2, 6. OG
Impact of epidural analgesia duration after liver surgery on complications and length of stay
G.-R. Joliat, I. Labgaa, N. Demartines, N. Halkic, Presenter: G.-R. Joliat (Lausanne)
Epidural analgesia (EDA) belongs to standard for pain management after hepatectomy. Some data have shown that EDA could be a risk factor for postoperative complications after liver surgery. The aim of the present study was to assess the impact of EDA duration on complications and length of stay (LoS) after liver resection.
A retrospective study of all consecutive patients with hepatectomy in our institution from 2010 to 2016 was performed. Complications were graded according to Clavien classification and the comprehensive complication index (CCI) was calculated. Multivariable analyses using binary logistic regressions were performed to find risk factors for complications and prolonged LoS. Patients with EDA failure were excluded.
A total of 285 patients had hepatectomy during the study period. Among them, 223 had EDA (78%). In the EDA group, 10% (23/223) of the operations were performed by laparoscopy. Overall complication rate and median CCI for the EDA group were 121/223 (54%) and 8.7 (IQR: 0-26.2), respectively. Median LoS was 8 days (IQR: 7-14). Median EDA duration was 4 days (IQR: 3-4) after the operation. The best EDA duration threshold for maximal sensitivity and specificity regarding postoperative complications based on a receiver operating characteristic curve was 5 days. Patients who had EDA ≥5 days had an overall complication rate of 76% (37/49) and patients who had EDA <5 days 47% (81/174, p<0.001). Median LoS was longer in patients with EDA ≥5 days compared to patients with EDA <5 days (16 days, IQR: 11-25 vs. 8 days, IQR: 7-12, p<0.001). On multivariable analysis, EDA duration ≥5 days was an independent risk factor for postoperative complications (HR: 2.7, 95% CI: 1.2-6.6, p=0.019) along age (HR: 1.1, p=0.016), cirrhosis (HR: 5.2, p=0.018), and operation time (HR: 1.1, p<0.001). EDA duration ≥5 days was also an independent predictor of LoS >8 days on multivariable analysis (HR: 8.4, 95% CI: 3.0-23.2, p<0.001).
In this cohort of patients with EDA as main postoperative pain management after liver surgery, EDA duration ≥5 days was associated with higher rate of postoperative complications and was predictive of longer LoS. For this reason, whenever possible EDA should be discontinued before the fifth postoperative day.