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The use of epidurals in abdominal wall reconstruction: an analysis of outcomes and cost.

Abstract：

BACKGROUND:Ventral hernias are a common, challenging, and expensive problem for general and reconstructive surgeons. The authors assessed the impact of epidurals on morbidity following abdominal wall reconstruction for hernia. METHODS:A retrospective review of abdominal wall reconstruction patients operated on between 2007 and 2012 was performed with a specific focus on the use of epidurals. Bivariate and multivariate logistic regression analyses were used to assess independent predictors of morbidity. Subgroup analyses were also performed. RESULTS:The study included 134 consecutive reconstructions performed by a single surgeon over a 5-year period at an academic teaching center. Patient groups were similar in terms of demographics, preoperative characteristics, hernia grade, and intraoperative characteristics. Epidural use was associated with a lower incidence of major surgical complications (19.7 percent versus 36.1 percent; p = 0.04) and medical complications (26.8 percent versus 54.1 percent; p = 0.001). A significant and independent reduction in medical morbidity (OR, 0.09; p ≤ 0.001) and unplanned reoperations (OR, 0.23; p = 0.052), was found with patients receiving epidurals. Furthermore, a notable trend toward reduced major surgical complications (OR, 0.45; p = 0.141) and cost savings (-$22,184; p = 0.01) was found in patients who received epidurals. Subgroup analysis did not demonstrate statistically significant reductions in major surgical morbidity in reconstruction either with (p = 0.13) or without (p = 0.07) concurrent intra abdominal procedures when epidurals were not or were used, respectively. CONCLUSIONS:Epidural use may be associated with reduced morbidity and cost savings in abdominal wall reconstruction. This effect appears to be related to reduced medical morbidity and shortened length of stay in patients undergoing more complex, concurrent intraabdominal hernia procedures. CLINICAL QUESTION/LEVEL OF EVIDENCE:Risk, II.

journal_name

Plast Reconstr Surg

journal_title

Plastic and reconstructive surgery

authors

Fischer JP,Nelson JA,Wes AM,Wink JD,Yan C,Braslow BM,Chen L,Kovach SJ

doi

10.1097/01.prs.0000438048.91139.31

subject

Has Abstract

pub_date

2014-03-01 00:00:00

pages

687-699

issue

eissn

0032-1052

issn

1529-4242

pii

00006534-201403000-00042

journal_volume

133

pub_type

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The use of epidurals in abdominal wall reconstruction: an analysis of outcomes and cost.