Perioperative remifentanil infusions have been postulated to help with recovery after surgery due to their rapid offset and predictable metabolism. However, evidence on patients undergoing abdominal surgery suggests an association between intraoperative remifentanil and longer length of stay in the post-anesthetic care unit, increased postoperative pain and analgesic requirement.We retrospectively evaluated 3648 adult patients who underwent major abdominal surgeries from 2013 to 2020 in a tertiary single center. Propensity score matching was conducted to balance 12 specific covariates between the treatment and control groups prior to further statistical analysis. We found that intraoperative remifentanil infusion was associated with an increased average hospital length of stay (10.62 in treatment group vs 10.13 in control group, 95% CI 0.048 - 0.088, P<0.001) and increased length of stay in the high dependency ward (1.89 days in treatment group vs 1.52 days in control group, 95% CI 0.126 - 0.223 P <0.001), but a shorter stay in the intensive care unit (4.03 hours in treatment group vs 7.01 hours in control group, 95% CI -0.509 - 0.452, P <0.001). Consistent with current evidence, there was no significant difference between the treatment and control groups for death in 3 months and 2 years post-surgery.In conclusion, our study suggests that remifentanil may not promote postoperative recovery as expected. Its role in enhancing recovery is debatable and further studies are needed to determine the cost effectiveness of remifentanil use in abdominal surgery.
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