Effect of postoperative epidural analgesia on morbidity and mortality after lung resection in Medicare patients

Christopher L. Wu, Adam Sapirstein, Robert Herbert, Andrew J. Rowlingson, Robert K. Michaels, Michelle Antonieta Petrovic, Lee A. Fleisher

Research output: Contribution to journalArticle

Abstract

Study Objective: To perform an analysis of the Medicare claims database in patients undergoing lung resection to determine whether there is an association between postoperative epidural analgesia and mortality. Design: Retrospective cohort (database) design. Setting: University hospital. Measurements: We examined a cohort of 3501 patients obtained from a 5% nationally random sample of 1997 to 2001 Medicare beneficiaries who underwent nonemergency segmental excision of the lung (International Classification of Diseases, 9th Revision, Clinical Modification codes 32.3 and 32.4). Patient data were divided into two groups depending on the presence or absence of billing for postoperative epidural analgesia (Current Procedural Terminology code 01996). The primary outcomes assessed were death at 7 and 30 days after the procedure. The rates of major morbidity (acute myocardial infarction, angina, cardiac dysrhythmias, heart failure, pneumonia, pulmonary edema, respiratory failure, deep venous thrombosis, pulmonary embolism, sepsis, acute renal failure, somnolence, acute cerebrovascular event, transient organic syndrome, and paralytic ileus) were also compared. Multivariate regression analysis incorporating race, gender, age, comorbidities, hospital size, hospital teaching status, and hospital technology status was performed to determine whether the presence of postoperative epidural analgesia had an independent effect on mortality or major morbidity. Main Results: Multivariate regression analysis showed that the presence of epidural analgesia was associated with a significantly lower odds of death at 7 days (odds ratio, 0.39; 95% confidence interval, 0.19-0.80; P = 0.001) and 30 days (odds ratio, 0.53; 95% confidence interval, 0.35-0.78; P = 0.002) after surgery. There was no difference between the groups with regard to overall major morbidity. Conclusions: Postoperative epidural analgesia may contribute to lower odds of death after segmental excision of the lung, although the mechanism of such a benefit is not clear from our analysis.

Original languageEnglish (US)
Pages (from-to)515-520
Number of pages6
JournalJournal of Clinical Anesthesia
Volume18
Issue number7
DOIs
StatePublished - Nov 2006

Fingerprint

Epidural Analgesia
Medicare
Morbidity
Lung
Mortality
Multivariate Analysis
Odds Ratio
Current Procedural Terminology
Regression Analysis
Health Facility Size
Insurance Claim Review
Databases
Confidence Intervals
Intestinal Pseudo-Obstruction
International Classification of Diseases
Pulmonary Edema
Pulmonary Embolism
Acute Kidney Injury
Teaching Hospitals
Venous Thrombosis

Keywords

  • Analgesia
  • Epidural
  • Medicare
  • Patient mortality
  • Postoperative pain
  • Thoracic surgery

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Effect of postoperative epidural analgesia on morbidity and mortality after lung resection in Medicare patients. / Wu, Christopher L.; Sapirstein, Adam; Herbert, Robert; Rowlingson, Andrew J.; Michaels, Robert K.; Petrovic, Michelle Antonieta; Fleisher, Lee A.

In: Journal of Clinical Anesthesia, Vol. 18, No. 7, 11.2006, p. 515-520.

Research output: Contribution to journalArticle

Wu, Christopher L. ; Sapirstein, Adam ; Herbert, Robert ; Rowlingson, Andrew J. ; Michaels, Robert K. ; Petrovic, Michelle Antonieta ; Fleisher, Lee A. / Effect of postoperative epidural analgesia on morbidity and mortality after lung resection in Medicare patients. In: Journal of Clinical Anesthesia. 2006 ; Vol. 18, No. 7. pp. 515-520.
@article{ea260d84ca6f43f8a683a4fff2a72afb,
title = "Effect of postoperative epidural analgesia on morbidity and mortality after lung resection in Medicare patients",
abstract = "Study Objective: To perform an analysis of the Medicare claims database in patients undergoing lung resection to determine whether there is an association between postoperative epidural analgesia and mortality. Design: Retrospective cohort (database) design. Setting: University hospital. Measurements: We examined a cohort of 3501 patients obtained from a 5{\%} nationally random sample of 1997 to 2001 Medicare beneficiaries who underwent nonemergency segmental excision of the lung (International Classification of Diseases, 9th Revision, Clinical Modification codes 32.3 and 32.4). Patient data were divided into two groups depending on the presence or absence of billing for postoperative epidural analgesia (Current Procedural Terminology code 01996). The primary outcomes assessed were death at 7 and 30 days after the procedure. The rates of major morbidity (acute myocardial infarction, angina, cardiac dysrhythmias, heart failure, pneumonia, pulmonary edema, respiratory failure, deep venous thrombosis, pulmonary embolism, sepsis, acute renal failure, somnolence, acute cerebrovascular event, transient organic syndrome, and paralytic ileus) were also compared. Multivariate regression analysis incorporating race, gender, age, comorbidities, hospital size, hospital teaching status, and hospital technology status was performed to determine whether the presence of postoperative epidural analgesia had an independent effect on mortality or major morbidity. Main Results: Multivariate regression analysis showed that the presence of epidural analgesia was associated with a significantly lower odds of death at 7 days (odds ratio, 0.39; 95{\%} confidence interval, 0.19-0.80; P = 0.001) and 30 days (odds ratio, 0.53; 95{\%} confidence interval, 0.35-0.78; P = 0.002) after surgery. There was no difference between the groups with regard to overall major morbidity. Conclusions: Postoperative epidural analgesia may contribute to lower odds of death after segmental excision of the lung, although the mechanism of such a benefit is not clear from our analysis.",
keywords = "Analgesia, Epidural, Medicare, Patient mortality, Postoperative pain, Thoracic surgery",
author = "Wu, {Christopher L.} and Adam Sapirstein and Robert Herbert and Rowlingson, {Andrew J.} and Michaels, {Robert K.} and Petrovic, {Michelle Antonieta} and Fleisher, {Lee A.}",
year = "2006",
month = "11",
doi = "10.1016/j.jclinane.2006.03.005",
language = "English (US)",
volume = "18",
pages = "515--520",
journal = "Journal of Clinical Anesthesia",
issn = "0952-8180",
publisher = "Elsevier Inc.",
number = "7",

}

TY - JOUR

T1 - Effect of postoperative epidural analgesia on morbidity and mortality after lung resection in Medicare patients

AU - Wu, Christopher L.

AU - Sapirstein, Adam

AU - Herbert, Robert

AU - Rowlingson, Andrew J.

AU - Michaels, Robert K.

AU - Petrovic, Michelle Antonieta

AU - Fleisher, Lee A.

PY - 2006/11

Y1 - 2006/11

N2 - Study Objective: To perform an analysis of the Medicare claims database in patients undergoing lung resection to determine whether there is an association between postoperative epidural analgesia and mortality. Design: Retrospective cohort (database) design. Setting: University hospital. Measurements: We examined a cohort of 3501 patients obtained from a 5% nationally random sample of 1997 to 2001 Medicare beneficiaries who underwent nonemergency segmental excision of the lung (International Classification of Diseases, 9th Revision, Clinical Modification codes 32.3 and 32.4). Patient data were divided into two groups depending on the presence or absence of billing for postoperative epidural analgesia (Current Procedural Terminology code 01996). The primary outcomes assessed were death at 7 and 30 days after the procedure. The rates of major morbidity (acute myocardial infarction, angina, cardiac dysrhythmias, heart failure, pneumonia, pulmonary edema, respiratory failure, deep venous thrombosis, pulmonary embolism, sepsis, acute renal failure, somnolence, acute cerebrovascular event, transient organic syndrome, and paralytic ileus) were also compared. Multivariate regression analysis incorporating race, gender, age, comorbidities, hospital size, hospital teaching status, and hospital technology status was performed to determine whether the presence of postoperative epidural analgesia had an independent effect on mortality or major morbidity. Main Results: Multivariate regression analysis showed that the presence of epidural analgesia was associated with a significantly lower odds of death at 7 days (odds ratio, 0.39; 95% confidence interval, 0.19-0.80; P = 0.001) and 30 days (odds ratio, 0.53; 95% confidence interval, 0.35-0.78; P = 0.002) after surgery. There was no difference between the groups with regard to overall major morbidity. Conclusions: Postoperative epidural analgesia may contribute to lower odds of death after segmental excision of the lung, although the mechanism of such a benefit is not clear from our analysis.

AB - Study Objective: To perform an analysis of the Medicare claims database in patients undergoing lung resection to determine whether there is an association between postoperative epidural analgesia and mortality. Design: Retrospective cohort (database) design. Setting: University hospital. Measurements: We examined a cohort of 3501 patients obtained from a 5% nationally random sample of 1997 to 2001 Medicare beneficiaries who underwent nonemergency segmental excision of the lung (International Classification of Diseases, 9th Revision, Clinical Modification codes 32.3 and 32.4). Patient data were divided into two groups depending on the presence or absence of billing for postoperative epidural analgesia (Current Procedural Terminology code 01996). The primary outcomes assessed were death at 7 and 30 days after the procedure. The rates of major morbidity (acute myocardial infarction, angina, cardiac dysrhythmias, heart failure, pneumonia, pulmonary edema, respiratory failure, deep venous thrombosis, pulmonary embolism, sepsis, acute renal failure, somnolence, acute cerebrovascular event, transient organic syndrome, and paralytic ileus) were also compared. Multivariate regression analysis incorporating race, gender, age, comorbidities, hospital size, hospital teaching status, and hospital technology status was performed to determine whether the presence of postoperative epidural analgesia had an independent effect on mortality or major morbidity. Main Results: Multivariate regression analysis showed that the presence of epidural analgesia was associated with a significantly lower odds of death at 7 days (odds ratio, 0.39; 95% confidence interval, 0.19-0.80; P = 0.001) and 30 days (odds ratio, 0.53; 95% confidence interval, 0.35-0.78; P = 0.002) after surgery. There was no difference between the groups with regard to overall major morbidity. Conclusions: Postoperative epidural analgesia may contribute to lower odds of death after segmental excision of the lung, although the mechanism of such a benefit is not clear from our analysis.

KW - Analgesia

KW - Epidural

KW - Medicare

KW - Patient mortality

KW - Postoperative pain

KW - Thoracic surgery

UR - http://www.scopus.com/inward/record.url?scp=33751159207&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33751159207&partnerID=8YFLogxK

U2 - 10.1016/j.jclinane.2006.03.005

DO - 10.1016/j.jclinane.2006.03.005

M3 - Article

C2 - 17126780

AN - SCOPUS:33751159207

VL - 18

SP - 515

EP - 520

JO - Journal of Clinical Anesthesia

JF - Journal of Clinical Anesthesia

SN - 0952-8180

IS - 7

ER -