TY - JOUR
T1 - Short-Term Outcomes of Epidural Analgesia in Minimally Invasive Esophagectomy for Esophageal Cancer
T2 - Nationwide Inpatient Data Study in Japan
AU - Hirano, Yuki
AU - Kaneko, Hidehiro
AU - Konishi, Takaaki
AU - Itoh, Hidetaka
AU - Matsuda, Satoru
AU - Kawakubo, Hirofumi
AU - Uda, Kazuaki
AU - Matsui, Hiroki
AU - Fushimi, Kiyohide
AU - Daiko, Hiroyuki
AU - Itano, Osamu
AU - Yasunaga, Hideo
AU - Kitagawa, Yuko
N1 - Funding Information:
This work was supported by grants from the Ministry of Health, Labour and Welfare, Japan (21AA2007 and 20AA2005) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (20H03907).
Funding Information:
Yuko Kitagawa has received grants from Chugai Pharmaceutical Co. Ltd, Taiho Pharmaceutical Co. Ltd, Yakult Honsha Co. Ltd, Asahi Kasei Pharma Corporation, Otsuka Pharmaceutical Co. Ltd, Ono Pharmaceutical Co. Ltd, Tsumura & Co., Kaken Pharmaceutical Co. Ltd, Dainippon Sumitomo Pharma Co. Ltd, EA Pharma Co. Ltd, Eisai Co. Ltd, Otsuka Pharmaceutical Factory Inc., Medicon Inc., Kyowa Hakko Kirin Co. Ltd, Takeda Pharmaceutical Co. Ltd, Toyama Chemical Co. Ltd, Astellas Pharma Inc., Teijin Pharma Limited, Nihon Pharmaceutical Co. Ltd, and Nippon Covidien Inc., as well as lecture fees from Chugai Pharmaceutical Co. Ltd, Taiho Pharmaceutical Co. Ltd, Asahi Kasei Pharma Co. Ltd, Otsuka Pharmaceutical Factory Inc., Ono Pharmaceutical Co. Ltd, Shionogi & Co. Ltd, AstraZeneca K.K., Nippon Covidien Inc., Ethicon Inc., Bristol-Myers Squibb K.K., and Olympus Co. Outside the submitted work. Yuki Hirano, Hidehiro Kaneko, Takaaki Konishi, Hidetaka Itoh, Satoru Matsuda, Hirofumi Kawakubo, Kazuaki Uda, Hiroki Matsui, Kiyohide Fushimi, Hiroyuki Daiko, Osamu Itano, and Hideo Yasunaga have no disclosures to report.
Publisher Copyright:
© 2022, Society of Surgical Oncology.
PY - 2022/12
Y1 - 2022/12
N2 - Background: Studies have shown that epidural analgesia (EDA) is associated with a decreased risk of pneumonia and anastomotic leakage after esophagectomy, and several guidelines strongly recommend EDA use after esophagectomy. However, the benefit of EDA use in minimally invasive esophagectomy (MIE) remains unclear. Objective: The aim of this retrospective study was to compare the short-term outcomes between patients with and without EDA undergoing MIE for esophageal cancer. Methods: Data of patients who underwent oncologic MIE (April 2014–March 2019) were extracted from a Japanese nationwide inpatient database. Stabilized inverse probability of treatment weighting (IPTW), propensity score matching, and instrumental variable analyses were performed to investigate the associations between EDA use and short-term outcomes, adjusting for potential confounders. Results: Among 12,688 eligible patients, EDA was used in 9954 (78.5%) patients. In-hospital mortality, respiratory complications, and anastomotic leakage occurred in 230 (1.8%), 2139 (16.9%), and 1557 (12.3%) patients, respectively. In stabilized IPTW, EDA use was significantly associated with decreased in-hospital mortality (odds ratio [OR] 0.46 [95% confidence interval 0.34–0.61]), respiratory complications (OR 0.74 [0.66–0.84]), and anastomotic leakage (OR 0.77 [0.67–0.88]). EDA use was also associated with decreased prolonged mechanical ventilation, unplanned intubation, nonsteroidal anti-inflammatory drug use, acetaminophen use, postoperative length of stay, and total hospitalization costs and increased vasopressor use. One-to-three propensity score matching and instrumental variable analyses demonstrated equivalent results. Conclusions: EDA use in oncologic MIE was associated with low in-hospital mortality as well as decreased respiratory complications, and anastomotic leakage, suggesting the potential advantage of EDA use in MIE.
AB - Background: Studies have shown that epidural analgesia (EDA) is associated with a decreased risk of pneumonia and anastomotic leakage after esophagectomy, and several guidelines strongly recommend EDA use after esophagectomy. However, the benefit of EDA use in minimally invasive esophagectomy (MIE) remains unclear. Objective: The aim of this retrospective study was to compare the short-term outcomes between patients with and without EDA undergoing MIE for esophageal cancer. Methods: Data of patients who underwent oncologic MIE (April 2014–March 2019) were extracted from a Japanese nationwide inpatient database. Stabilized inverse probability of treatment weighting (IPTW), propensity score matching, and instrumental variable analyses were performed to investigate the associations between EDA use and short-term outcomes, adjusting for potential confounders. Results: Among 12,688 eligible patients, EDA was used in 9954 (78.5%) patients. In-hospital mortality, respiratory complications, and anastomotic leakage occurred in 230 (1.8%), 2139 (16.9%), and 1557 (12.3%) patients, respectively. In stabilized IPTW, EDA use was significantly associated with decreased in-hospital mortality (odds ratio [OR] 0.46 [95% confidence interval 0.34–0.61]), respiratory complications (OR 0.74 [0.66–0.84]), and anastomotic leakage (OR 0.77 [0.67–0.88]). EDA use was also associated with decreased prolonged mechanical ventilation, unplanned intubation, nonsteroidal anti-inflammatory drug use, acetaminophen use, postoperative length of stay, and total hospitalization costs and increased vasopressor use. One-to-three propensity score matching and instrumental variable analyses demonstrated equivalent results. Conclusions: EDA use in oncologic MIE was associated with low in-hospital mortality as well as decreased respiratory complications, and anastomotic leakage, suggesting the potential advantage of EDA use in MIE.
UR - http://www.scopus.com/inward/record.url?scp=85135854341&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85135854341&partnerID=8YFLogxK
U2 - 10.1245/s10434-022-12346-x
DO - 10.1245/s10434-022-12346-x
M3 - Article
C2 - 35960454
AN - SCOPUS:85135854341
SN - 1068-9265
VL - 29
SP - 8225
EP - 8234
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 13
ER -
