• Dominic E Sanford, William G Hawkins, and Ryan C Fields.
• Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO, USA.
• HPB (Oxford). 2015 Jun 1; 17 (6): 551-8.

BackgroundIn spite of limited evidence demonstrating a benefit, epidural analgesia (EA) is often used for patients undergoing a pancreatectomy. In the present study, the impact of epidural analgesia on post-operative outcomes after a pancreatectomy is examined.MethodsUtilizing the Nationwide Inpatient Sample, the effect of EA on peri-operative outcomes after a pancreatectomy was examined. Multivariable logistic and linear regression with propensity score matching were utilized for risk adjustment.ResultsFrom 2008-2011, 12,440 patients underwent a pancreatectomy. Of these, 1130 (9.1%) patients received epidural analgesia. Using univariate comparison, patients receiving EA had a significantly decreased length of stay (LOS), hospital charges and post-operative inpatient mortality. In multivariate analyses, EA was independently associated with a decreased post-operative LOS (adjusted mean difference = -1.19 days, P < 0.001), decreased hospital charges (adjusted mean difference = -$16,814, P = 0.002) and decreased post-operative inpatient mortality [adjusted odds ratio (OR) = 0.42, P < 0.001]. Using 1:1 propensity score matching, patients who received an EA (n = 1070) had significantly decreased post-operative LOS (11.0 versus 12.1 days, P = 0.011), lower hospital charges ($112,086 versus $128,939, P = 0.001) and decreased post-operative inpatient mortality (1.5% versus 3.6%, P = 0.002) compared with matched controls without EA (n = 1070).ConclusionAnalysis of a large hospital database reveals that EA is associated with improved peri-operative outcomes after a pancreatectomy. Additional studies are required to understand fully if this relationship is causal.© 2015 International Hepato-Pancreato-Biliary Association.

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