Epidural anaesthesia and survival after intermediate-to-high risk non-cardiac surgery: a population-based cohort study Export

@article{citeulike:3177264, abstract = {SummaryBackground Although epidural anaesthesia and analgesia have numerous benefits, their effects on postoperative survival are unclear. We therefore undertook a population-based cohort study to determine whether perioperative epidural anaesthesia or analgesia is associated with improved 30-day survival.Methods We used population-based linked administrative databases to do a retrospective cohort study of 259[punctuation space]037 patients, aged 40 years or older, who underwent selected elective intermediate-to-high risk non-cardiac surgical procedures between April 1, 1994, and March 31, 2004, in Ontario, Canada. Propensity-score methods were used to construct a matched-pairs cohort that reduced important baseline differences between patients who received epidural anaesthesia or analgesia as opposed to those that did not. We then determined the association of epidural anaesthesia with 30-day mortality within these matched-pairs.Findings Of the 259[punctuation space]037 patients, 56[punctuation space]556 (22\%) received epidural anaesthesia. Within the matched-pairs cohort (n=88[punctuation space]188), epidural anaesthesia was associated with a small reduction in 30-day mortality (1·7\% vs 2·0\%; relative risk 0·89, 95\% CI 0·81-0·98, p=0·02).Interpretation Epidural anaesthesia and analgesia were associated with a small improvement in 30-day survival, but this effect should be interpreted cautiously. The estimate had borderline significance, despite a large sample size. Its absolute magnitude was also small, corresponding to a number needed to treat of 477. Our study, therefore, does not provide compelling evidence that epidural anaesthesia improves postoperative survival. Nonetheless, our results support the safety of perioperative epidural anaesthesia when used for indications other than improving survival (eg, improving postoperative pain relief, preventing postoperative pulmonary complications).Funding Institute for Clinical Evaluative Sciences.}, author = {Wijeysundera, Duminda N. and Beattie, Scott W. and Austin, Peter C. and Hux, Janet E. and Laupacis, Andreas}, citeulike-article-id = {3177264}, citeulike-linkout-0 = {http://dx.doi.org/10.1016/S0140-6736(08)61121-6}, citeulike-linkout-1 = {http://www.sciencedirect.com/science/article/B6T1B-4T5M97G-1/2/ca4eea9e7e3a0cbd7f7345a8bff875df}, doi = {10.1016/S0140-6736(08)61121-6}, journal = {The Lancet}, keywords = {acute-pain, epidural, observational-study}, number = {9638}, pages = {562--569}, posted-at = {2008-09-01 03:25:59}, priority = {4}, title = {Epidural anaesthesia and survival after intermediate-to-high risk non-cardiac surgery: a population-based cohort study}, url = {http://dx.doi.org/10.1016/S0140-6736(08)61121-6}, volume = {372} }

TY - JOUR ID - citeulike:3177264 L3 - citeulike-article-id:3177264 N2 - SummaryBackground Although epidural anaesthesia and analgesia have numerous benefits, their effects on postoperative survival are unclear. We therefore undertook a population-based cohort study to determine whether perioperative epidural anaesthesia or analgesia is associated with improved 30-day survival.Methods We used population-based linked administrative databases to do a retrospective cohort study of 259[punctuation space]037 patients, aged 40 years or older, who underwent selected elective intermediate-to-high risk non-cardiac surgical procedures between April 1, 1994, and March 31, 2004, in Ontario, Canada. Propensity-score methods were used to construct a matched-pairs cohort that reduced important baseline differences between patients who received epidural anaesthesia or analgesia as opposed to those that did not. We then determined the association of epidural anaesthesia with 30-day mortality within these matched-pairs.Findings Of the 259[punctuation space]037 patients, 56[punctuation space]556 (22%) received epidural anaesthesia. Within the matched-pairs cohort (n=88[punctuation space]188), epidural anaesthesia was associated with a small reduction in 30-day mortality (1·7% vs 2·0%; relative risk 0·89, 95% CI 0·81-0·98, p=0·02).Interpretation Epidural anaesthesia and analgesia were associated with a small improvement in 30-day survival, but this effect should be interpreted cautiously. The estimate had borderline significance, despite a large sample size. Its absolute magnitude was also small, corresponding to a number needed to treat of 477. Our study, therefore, does not provide compelling evidence that epidural anaesthesia improves postoperative survival. Nonetheless, our results support the safety of perioperative epidural anaesthesia when used for indications other than improving survival (eg, improving postoperative pain relief, preventing postoperative pulmonary complications).Funding Institute for Clinical Evaluative Sciences. IS - 9638 JF - The Lancet EP - 569 TI - Epidural anaesthesia and survival after intermediate-to-high risk non-cardiac surgery: a population-based cohort study VL - 372 SP - 562 KW - acute-pain KW - epidural KW - observational-study AU - Wijeysundera, Duminda AU - Beattie, Scott AU - Austin, Peter AU - Hux, Janet AU - Laupacis, Andreas UR - http://dx.doi.org/10.1016/S0140-6736(08)61121-6 ER -