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The Use of Epidurals in Abdominal Wall Reconstruction: An Analysis of Outcomes and Cost

Fischer, John P. M.D.; Nelson, Jonas A. M.D.; Wes, Ari M. B.A.; Wink, Jason D. B.A.; Yan, Chen B.A.; Braslow, Benjamin M. M.D.; Chen, Linda M.D.; Kovach, Stephen J. M.D.

Plastic and Reconstructive Surgery: March 2014 - Volume 133 - Issue 3 - p 687–699
doi: 10.1097/01.prs.0000438048.91139.31
Reconstructive: Trunk: Original Articles
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Background: Ventral hernias are a common, challenging, and expensive problem for general and reconstructive surgeons. The authors assessed the impact of epidurals on morbidity following abdominal wall reconstruction for hernia.

Methods: A retrospective review of abdominal wall reconstruction patients operated on between 2007 and 2012 was performed with a specific focus on the use of epidurals. Bivariate and multivariate logistic regression analyses were used to assess independent predictors of morbidity. Subgroup analyses were also performed.

Results: The study included 134 consecutive reconstructions performed by a single surgeon over a 5-year period at an academic teaching center. Patient groups were similar in terms of demographics, preoperative characteristics, hernia grade, and intraoperative characteristics. Epidural use was associated with a lower incidence of major surgical complications (19.7 percent versus 36.1 percent; p = 0.04) and medical complications (26.8 percent versus 54.1 percent; p = 0.001). A significant and independent reduction in medical morbidity (OR, 0.09; p ≤ 0.001) and unplanned reoperations (OR, 0.23; p = 0.052), was found with patients receiving epidurals. Furthermore, a notable trend toward reduced major surgical complications (OR, 0.45; p = 0.141) and cost savings (−$22,184; p = 0.01) was found in patients who received epidurals. Subgroup analysis did not demonstrate statistically significant reductions in major surgical morbidity in reconstruction either with (p = 0.13) or without (p = 0.07) concurrent intra abdominal procedures when epidurals were not or were used, respectively.

Conclusions: Epidural use may be associated with reduced morbidity and cost savings in abdominal wall reconstruction. This effect appears to be related to reduced medical morbidity and shortened length of stay in patients undergoing more complex, concurrent intraabdominal hernia procedures.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Philadelphia, Pa.

From the Division of Plastic Surgery, and the Department of Anesthesia, Hospital of the University of Pennsylvania.

Received for publication July 23, 2013; accepted September 17, 2013.

Disclosure: None of the authors has any relevant conflicts of interest to report. No external or internal funding was used for this study.

John P. Fischer, M.D., Division of Plastic Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, Pa. 19104, john.fischer2@uphs.upenn.edu

©2014American Society of Plastic Surgeons