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Epidural anesthesia may be associated with increased postoperative complications in the elderly population undergoing radical cystectomy: an analysis from the National Surgical Quality Improvement Project (NSQIP) database

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Abstract

Background

Epidural anesthesia has been associated with a decrease in cardiopulmonary complications and a decrease in blood loss in orthopedic procedures. Its influence on the outcomes of patients receiving radical cystectomies is unknown. We aim to use the large national database from the National Surgical Quality Improvement Project (NSQIP) to examine whether postoperative complications may be affected by the use of epidural anesthesia during radical cystectomy.

Methods

Data were collected from the 2014–2016 participant user files of the NSQIP database. Patients receiving radical cystectomy were identified by CPT code and further stratified by anesthesia type. Demographics, length of stay, and 30-day complications including death were collected and analyzed using univariable and multivariable analysis.

Results

A total of 6448 patients met the inclusion criteria for analysis. Between 2014 and 2016, 5064 patients received general anesthesia only (GA) and 1384 patients received general and epidural anesthesia (GEA). Statistical analysis showed an overall increase in major complications (17.8% vs 18.5%) in the GEA group (p = 0.0046). Subgroup analysis showed major complications to be more likely in patients older than 75 years receiving GEA instead of GA (p = 0.0301).

Conclusions

Elderly patients (age > 75) undergoing radical cystectomy may experience more major complications with the use of epidural anesthesia. This may be due to end-organ effects from the hemodynamic changes of epidural anesthesia which are poorly tolerated in the elderly population. Further single intervention epidural studies need to be performed to isolate the effects of epidural anesthesia on individual surgical procedures.

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Authors and Affiliations

  1. Department of Anesthesiology, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA

    Sephalie Y. Patel

  2. Morsani College of Medicine, University of South Florida, Tampa, FL, USA

    Robert S. Ackerman

  3. Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Robert S. Ackerman

  4. Department of Biostatistics, H. Lee Moffitt Cancer Center, Tampa, FL, USA

    David Boulware

  5. Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA

    Michael A. Poch

Authors
  1. Sephalie Y. Patel
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  2. Robert S. Ackerman
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  3. David Boulware
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  4. Michael A. Poch
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Contributions

SYP: protocol/ project development, data collection and management, manuscript writing. RSA: data analysis, manuscript writing. DB: data analysis, manuscript writing. MAP: protocol/ project development, data collection and management, manuscript writing.

Corresponding author

Correspondence to Sephalie Y. Patel.

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Exemption from Institutional Review Board approval.

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Informed consent was granted by the Protocol Review and Regulatory Affairs Committee due to use of only deidentified patient data.

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Patel, S.Y., Ackerman, R.S., Boulware, D. et al. Epidural anesthesia may be associated with increased postoperative complications in the elderly population undergoing radical cystectomy: an analysis from the National Surgical Quality Improvement Project (NSQIP) database. World J Urol 39, 433–441 (2021). https://doi.org/10.1007/s00345-020-03212-0

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  • DOI: https://doi.org/10.1007/s00345-020-03212-0

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