Epidural Use At Radical Cystectomy Is Associated With Higher Perioperative Morbidity And Increased Readmission Rates Without Improving Disease Specific Survival: A Population Based Study

You have accessJournal of UrologyBladder Cancer: Invasive IV (PD47)1 Apr 2019PD47-10 EPIDURAL USE AT RADICAL CYSTECTOMY IS ASSOCIATED WITH HIGHER PERIOPERATIVE MORBIDITY AND INCREASED READMISSION RATES WITHOUT IMPROVING DISEASE SPECIFIC SURVIVAL: A POPULATION BASED STUDY Brady L. Miller*, E. Jason Abel, Glenn O. Allen, Jessica R. Schumacher, David F. Jarrard, Tracy M. Downs, and Kyle A. Richards Brady L. Miller*Brady L. Miller* More articles by this author , E. Jason AbelE. Jason Abel More articles by this author , Glenn O. AllenGlenn O. Allen More articles by this author , Jessica R. SchumacherJessica R. Schumacher More articles by this author , David F. JarrardDavid F. Jarrard More articles by this author , Tracy M. DownsTracy M. Downs More articles by this author , and Kyle A. RichardsKyle A. Richards More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556766.61865.2dAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Epidural anesthesia is used to improve pain control after major surgery and has been associated with improved survival in some non-urologic cancers. Perioperative epidural use may reduce recurrence of non-muscle invasive bladder cancer. However, few data describe the impact of epidural use for bladder cancer patients treated with radical cystectomy. Here, we evaluate epidural use on perioperative and long-term outcomes for patients treated with radical cystectomy for bladder cancer. METHODS: Patients who received radical cystectomy for non-metastatic bladder urothelial carcinoma with epidural (n=1,748) and without epidural (n=6,109) anesthesia from 2002-2014 were identified using Surveillance, Epidemiology and End Results-Medicare data. Radical cystectomy outcomes with and without epidural anesthesia were compared using propensity score weighting. RESULTS: Epidural use at time of radical cystectomy was identified in 1,748 (22.2%) of 7,857 patients who met inclusion criteria. After propensity score weighted adjustment, epidural use was associated with increased 30-day readmission (29.6% vs. 26.2%, p<0.001), increased median length of stay in days (9.0, IQR 7.0-12.0 vs 8.0, IQR 6.0-12.0, p<0.01), and decreased likelihood of being discharged directly to home without need for home health or skilled nursing care (21.6% vs 29.1%, p<0.001). Post operative MI (2.6% vs 1.3%, p<0.001) and stroke (4.7% vs 3.9%, p=0.028 in the first 30 days after radical cystectomy was more common in the epidural group, but perioperative 30-day mortality was similar (3.3% vs 2.9%, p=0.205). Epidural use was not associated with increased cancer specific (HR 0.96, 0.90-1.02, p=0.20) or overall survival (HR 0.99, 0.95-1.04, p=0.73). CONCLUSIONS: Epidural use at time of radical cystectomy is associated with increased risk of perioperative complications, hospital readmission, and longer hospitalization without improving disease specific survival. Source of Funding: None Madison, WI© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e841-e841 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brady L. Miller* More articles by this author E. Jason Abel More articles by this author Glenn O. Allen More articles by this author Jessica R. Schumacher More articles by this author David F. Jarrard More articles by this author Tracy M. Downs More articles by this author Kyle A. Richards More articles by this author Expand All Advertisement PDF downloadLoading ...