Decreasing use of epidural analgesia with increasing minimally invasive lobectomy: Impact on postoperative morbidity Journal Article


Authors: Zeltsman, M.; Dozier, J.; Vaghjiani, R. G.; Poch, A.; Eguchi, T.; Pedoto, A.; Jones, D. R.; Adusumilli, P. S.
Article Title: Decreasing use of epidural analgesia with increasing minimally invasive lobectomy: Impact on postoperative morbidity
Abstract: Objective: The goal of this study is to investigate the use of EA and its impact on the postoperative short-term outcomes of patients with non-small cell lung cancer (NSCLC) who received a lobectomy by either minimally invasive surgery (MIS) or thoracotomy. Materials and methods: We investigated 793 patients who underwent lobectomy for pathological stage I-III NSCLC without induction therapy during two time periods, an early-time period (2009-2010: MIS, n = 204 [53%]; and thoracotomy, n = 182 [47%]) and a late-period (2014-2015: MIS, n = 308 [76%]; and thoracotomy, n = 99 [24%]). Patient characteristics, including pulmonary function tests, comorbidities, and use of EA, as well as short-term outcomes, including length of stay, morbidity, and mortality were assessed and compared between early-and late-time periods. We also compared patients who received EA (n = 150) with patients who did not receive EA (n = 158) following MIS lobectomy in the late-time period. Results: The use of MIS lobectomy increased during the late-time period compared to the early-time period (p < 0.001). In patients who underwent MIS lobectomy, the use of EA significantly decreased in the late-time period compared to the early-time period (2009-2010 vs. 2014-2015, 95% vs. 51%; p < 0.001). There was no difference in postoperative morbidity and mortality between the two time periods in both MIS and thoracotomy. In the late-time period MIS group, the length of stay in the no EA group (n = 150) was shorter than that in the EA group (n = 158) (3 vs. 4 days, p = 0.038). There was no difference in morbidity and mortality between the EA and no EA groups. Conclusion: In our study cohort, the observed decrease in the use of EA with the increasing rate of MIS lobectomy did not negatively affect postoperative short-term outcomes. © 2019 Elsevier B.V.
Keywords: adult; controlled study; aged; major clinical study; cancer patient; cancer staging; lung lobectomy; thoracotomy; morbidity; cohort analysis; retrospective study; length of stay; comorbidity; surgical mortality; minimally invasive surgery; lung function test; epidural analgesia; lobectomy; non-small cell lung cancer; video-assisted thoracoscopic surgery; postoperative analgesia; non small cell lung cancer; human; male; female; priority journal; article
Journal Title: Lung Cancer
Volume: 139
ISSN: 0169-5002
Publisher: Elsevier Ireland Ltd.  
Date Published: 2020-01-01
Start Page: 68
End Page: 72
Language: English
DOI: 10.1016/j.lungcan.2019.11.001
PUBMED: 31743888
PROVIDER: scopus
DOI/URL:
Notes: Article -- Source: Scopus
Altmetric Score
MSK Authors
  1. Alessia C Pedoto
    13 Pedoto
  2. David Randolph Jones
    175 Jones
  3. Takashi   Eguchi
    64 Eguchi
  4. Jordan Michael Dozier
    6 Dozier
  5. Alexandra Moreau Poch
    2 Poch