Epidural Analgesia after Liver Resection: A Comprehensive Audit on Failure Rates, Causes and Impact of an Advanced Practice Provider-Led Program

Sarah S Zhu1, Pilar Suz2, Andrew Sinnamon1, Eric Luo1, Jason Denbo1 and Daniel A Anaya1*

1Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, USA
2Department of Anesthesiology, H. Lee Moffitt Cancer Center & Research Institute, USA

^*Correspondance to: Daniel A Anaya 

 PDF  Full Text DOI: 10.25107/2474-1647.3529

Abstract

Background: Thoracic Epidural Analgesia (TEA) is recommended for pain control following hepatecomy. Recent data questioned this approach arguing increased risk of postoperative complications and Length of hospital Stay (LOS). It is unclear if such outcomes are related to TEA management, and whether a focused inpatient surgical service can mitigate adverse events. Methods: A retrospective cohort study including patients having open liver resection at a highvolume center was performed (2016-2021). Patients were categorized into TEA and No-TEA groups, and overall outcomes compared. The primary outcome of the study was TEA failure rate. Univariate and multivariate logistic regression analysis were performed to examine the impact of an Advanced Practice Provider (APP)-led inpatient surgical service on TEA failure rates. Results: A total of 517 patients were included; 361 in the TEA group (70%) and 156 in the No-TEA group (30%). There were no significant differences between the TEA and No-TEA groups in grade 3 to 4 postoperative complications (11.1% vs. 10.3%, p=0.78), median LOS (5 days [4-7] vs. 5 days [4-7]; p=0.8), and in overall textbook outcomes (66.7% vs. 70.5%, p=0.4). Failure rate was 26.5% and was significantly more common before as compared to after the APP-led program implementation (33.3% vs. 20.9%, p=0.008). On multivariate analysis, care under the APP-led program was associated with lower risk of TEA failure (OR 0.52 [95% CI 0.31-0.85], p=0.009). Conclusion: TEA is safe for postoperative pain control after hepatectomy. Failure rates occur in one fourth of patients and can be minimized by implementing an APP-led focused hepatobiliary surgical inpatient service.

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Cite the article

Zhu SS, Suz P, Sinnamon A, Luo E, Denbo J, Anaya DA. Epidural Analgesia after Liver Resection: A Comprehensive Audit on Failure Rates, Causes and Impact of an Advanced Practice Provider-Led Program. Clin Surg. 2022; 7: 3529..