Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2026
Comparative analysis of outcomes and costs of lung and esophageal resection: epidural analgesia vs peripheral nerve block.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Alizai Qaidar, Sarfraz Azza, Chatzipanagiotou Odysseas P, Mevawalla Areesh, Angez Meher, Elemosho Abdulaziz, Kneurtz Peter, D'Souza Desmond, Merritt Robert, Pawlik Timothy M
Аннотация
BACKGROUND: Thoracic epidural analgesia (EA) has historically been a key component of multimodal analgesia after open thoracotomy. EA use has decreased over time, however, and peripheral nerve blocks (PNBs) are increasingly used as alternatives. This study aimed to compare outcomes among patients receiving EA versus PNB as part of a lung or esophageal operative procedure.
METHODS: Adult patients who received EA or PNB as part of a lung or esophageal operative procedure from 2016 to 2020 were identified in the Nationwide Readmissions Database. Outcomes included complications, 90-day readmission, mortality, length of stay (LOS), and hospitalization costs. Patients were stratified according to analgesia type and 1:2 propensity score matching (PSM) adjusted for patient, surgical, and hospital characteristics. Multivariate regression was used to address residual confounding.
RESULTS: Among 8668 patients, 738 (8.5%) received EA, and 7930 (91.5%) received PNB. After PSM (N = 2110; 721 in the EA group vs 1389 in the PNB group), EA remained associated with longer LOS (β = 1.12 days [95% CI, 0.85-1.39]) and higher index admission (β = $3630 [95% CI, $2061-5199]) and total 90-day costs (β = $4808 [95% CI, $3230-$6386]) (all P <.001). In site-stratified multivariate models, EA was associated with higher median 90-day costs after esophageal resection ($12,487) and lung resection ($2970) and longer LOS (esophagus: β = 1.93; lung: β = 1.00 days). In addition, EA was associated with higher odds of ileus after esophageal resection (adjusted odds ratio, 18.47). Other complications, readmission, and 90-day mortality did not differ (all P >.05).
CONCLUSION: EA was associated with a longer hospital stay and higher median costs than PNB, with no differences in clinical outcomes. These findings support the use of PNB as an equally safe and more cost-conscious analgesic strategy in thoracic surgery.
METHODS: Adult patients who received EA or PNB as part of a lung or esophageal operative procedure from 2016 to 2020 were identified in the Nationwide Readmissions Database. Outcomes included complications, 90-day readmission, mortality, length of stay (LOS), and hospitalization costs. Patients were stratified according to analgesia type and 1:2 propensity score matching (PSM) adjusted for patient, surgical, and hospital characteristics. Multivariate regression was used to address residual confounding.
RESULTS: Among 8668 patients, 738 (8.5%) received EA, and 7930 (91.5%) received PNB. After PSM (N = 2110; 721 in the EA group vs 1389 in the PNB group), EA remained associated with longer LOS (β = 1.12 days [95% CI, 0.85-1.39]) and higher index admission (β = $3630 [95% CI, $2061-5199]) and total 90-day costs (β = $4808 [95% CI, $3230-$6386]) (all P <.001). In site-stratified multivariate models, EA was associated with higher median 90-day costs after esophageal resection ($12,487) and lung resection ($2970) and longer LOS (esophagus: β = 1.93; lung: β = 1.00 days). In addition, EA was associated with higher odds of ileus after esophageal resection (adjusted odds ratio, 18.47). Other complications, readmission, and 90-day mortality did not differ (all P >.05).
CONCLUSION: EA was associated with a longer hospital stay and higher median costs than PNB, with no differences in clinical outcomes. These findings support the use of PNB as an equally safe and more cost-conscious analgesic strategy in thoracic surgery.