Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jan;64(1):104-111.
doi: 10.1111/aas.13461. Epub 2019 Sep 17.

The association between epidural analgesia and mortality in emergency abdominal surgery: A population-based cohort study

Morten Vester-Andersen  1 , Lars Hyldborg Lundstrøm  2 , Morten Hylander Møller  3 ; Danish Anaesthesia Database
Affiliations

The association between epidural analgesia and mortality in emergency abdominal surgery: A population-based cohort study

Morten Vester-Andersen et al. Acta Anaesthesiol Scand. 2020 Jan.

Abstract

Background: Emergency abdominal surgery carries a considerable risk of mortality and post-operative complications, including pulmonary complications. In major elective surgery, epidural analgesia reduces mortality and pulmonary complications. We aimed to evaluate the association between epidural analgesia and mortality in emergency abdominal surgery.

Methods: In this population-based cohort study with prospective data collection, we included adults undergoing emergency abdominal laparotomy or laparoscopy between 1 January 2009 and 31 December 2010 at 13 Danish hospitals. Appendectomies were excluded. The primary outcome was 90-day mortality. Secondary outcomes included 30-day mortality and serious adverse events. We used binary logistic regression analyses (odds ratios (ORs) with 95% confidence intervals (CIs)).

Results: We included 4920 patients, of whom 1134 (23.0%) died within 90 days. Overall, 27.9% of the patients were treated with epidural analgesia perioperatively. This increased to 34.0% among patients undergoing major laparotomy. The crude and adjusted association between epidural analgesia and 90-day mortality was OR 0.99 (95%CI: 0.86-1.15, P = .94) and OR 0.80 (95%CI: 0.67-0.94; P = .01), respectively. For 30-day mortality the corresponding estimates were OR 0.90 (95% CI: 0.76-1.06, P = .21) and OR 0.75 (95% CI: 0.62-0.90, P < .01), respectively. No serious adverse events were reported.

Conclusion: In this population-based cohort study of adult patients undergoing emergency abdominal surgery, we found that the use of epidural analgesia perioperatively was associated with a decreased risk of mortality in the adjusted analysis.

Keywords: Emergency; epidural analgesia; general surgery; laparotomy; mortality.

PubMed Disclaimer

References

REFERENCES

    1. Jeppesen MM, Thygesen LC, Ekeloef S, Gögenur I. A nationwide cohort study of short- and long-term outcomes following emergency laparotomy. Dan. Med J. 2019;66:A5523.
    1. NELA Project Team. Fourth Patient Report of the National Emergency Laparotomy Audit (NELA).RCoA. London. 2018.
    1. Al-Temimi MH, Griffee M, Enniss TM, et al. When is death inevitable after emergency laparotomy? Analysis of the american college of surgeons national surgical quality improvement program database. J Am Coll Surg. 2012;215:503-511.
    1. Tengberg LT, Cihoric M, Foss NB, et al. Complications after emergency laparotomy beyond the immediate postoperative period - a retrospective, observational cohort study of 1139 patients. Anaesthesia. 2017;72:309-316.
    1. Tolstrup MB, Watt SK, Gögenur I. Morbidity and mortality rates after emergency abdominal surgery: an analysis of 4346 patients scheduled for emergency laparotomy or laparoscopy.Langenbeck’s. Arch Surg. 2017;402:615-623.

Publication types

LinkOut - more resources