Epidural Anesthesia Improves Outcome and Resource Use in Cardiac Surgery: A Single-Center Study of a 1293-Patient Cohort

Abstract

Thoracic epidural anesthesia (TEA) combined with general anesthesia in cardiac surgery has the potential to initiate earlier spontaneous ventilation and extubation, improved hemodynamics, less arrhythmia or myocardial ischemia, and an attenuated neurohormonal response. The aim of the current study was to characterize the correlation between TEA and postoperative resource use or outcome in a consecutive-patient cohort. The study was performed in a tertiary care, 3-surgeon, university-affiliated hospital that performs 350 to 400 cardiac surgeries per year. All 1293 adult patients who underwent cardiac surgery between July 1, 2002, and February 1, 2006, were included. Patients were assigned to anesthesiologists practicing TEA (TEA group, n = 506) or not (control group, n = 787) for cardiac surgery. The preoperative parameter values and Parsonnet scores for the 2 groups were similar. The 2 groups had the same distribution of surgery types. The TEA group presented with fewer intensive care unit (ICU) complications, such as delirium, pneumonia, and acute renal failure, and presented with better myocardial protection. The TEA group presented with a higher proportion of immediately postoperative extubations and with shorter ventilation times and ICU stays. Total ICU costs decreased from US $18,700 to $9900 per patient. Combining TEA and general anesthesia for cardiac surgery allows a significant change in anesthesia strategy. This change improves immediate postoperative outcomes and reduces the use and costs of ICU resources.

Comparison of continuous thoracic epidural analgesia with bilateral erector spinae plane block for perioperative pain management in cardiac surgery

“…Bracco et al . [ 16 ] have reported a minimal postoperative complications such as myocardial dysfunction, pneumonia, acute renal failure, and delirium in cardiac surgical patients who were administered TEA combined with GA compared with GA alone. They also reported a shorter ICU and hospital stay resulting in decreased calculated cost saving per person if the TEA was used.…”

High thoracic epidural anaesthesia for cardiac surgery

“…These changes equalized by day 3, and there was no difference in the incidence of atrial fibrillation. Bracco et al [16 ] reported a single-centre audit of patients grouped by HTEA or not. They found fewer intensive care unit complications (delirium, pneumonia and acute renal failure), reduced shorter ventilation times and lower intensive care unit cost.…”

Effect of thoracic epidural analgesia on clinical outcomes following transapical transcatheter aortic valve implantation

“…Indeed, the deleterious effects of thoracotomy on pulmonary function might be even more pronounced in elderly patients, who frequently exhibit a reduced pulmonary capacity prior to the intervention 27. The use of TEA in thoracic and cardiac surgery has been associated with a significant improvement in postoperative pulmonary function, shorter time to extubation, and a lower rate of pulmonary complications, such as pneumonia or respiratory insufficiency 8 23 28. The present study showed that TEA was associated with a more rapid extubation time and a dramatic reduction in pulmonary complications, such as nosocomial pneumonia, or the need for orotracheal reintubation or tracheostomy due to respiratory failure following TA-TAVI.…”