Regional analgesia and surgical site infections after colorectal surgery: a retrospective cohort analysis
Analgesia regional e infecções de sítio cirúrgico após cirurgia colorretal: uma análise de coorte retrospectiva
Gausan Ratna Bajracharya, Wael Ali Sakr Esa, Guangmei Mao, Steve Leung, Barak Cohen, Kamal Maheshwari, Hermann P. Kessler, Emre Gorgun, Daniel I. Sessler, Alparslan Turan
Abstract
Background
The effect of regional analgesia on perioperative infectious complications remains unknown. We therefore tested the hypothesis that a composite of serious infections after colorectal surgery is less common in patients with regional analgesia than in those given Intravenous Patient-Controlled Analgesia (IV-PCA) with opiates.
Methods
Patients undergoing elective colorectal surgery lasting one hour or more under general anesthesia at the Cleveland Clinic Main Campus between 2009 and 2015 were included in this retrospective analysis. Exposures were defined as regional postoperative analgesia with epidurals or Transversus Abdominis Plane blocks (TAP); or IV-PCA with opiates only. The outcome was defined as a composite of in-hospital serious infections, including intraabdominal abscess, pelvic abscess, deep or organ-space Surgical Site Infection (SSI), clostridium difficile, pneumonia, or sepsis. Logistic regression model adjusted for the imbalanced potential confounding factors among the subset of matched surgeries was used to report the odds ratios along with 95% confidence limits. The significance criterion was p < 0.05.
Results
A total of 7811 patients met inclusion and exclusion criteria of which we successfully matched 681 regional anesthesia patients to 2862 IV-PCA only patients based on propensity scores derived from potential confounding factors. There were 82 (12%) in-hospital postoperative serious infections in the regional analgesia group vs. 285 (10%) in IV-PCA patients. Regional analgesia was not significantly associated with serious infection (odds ratio: 1.14; 95% Confidence Interval 0.87‒1.49; p-value = 0.339) after adjusting for surgical duration and volume of intraoperative crystalloids.
Conclusion
Regional analgesia should not be selected as postoperative analgesic technique to reduce infections.
Keywords
Resumo
Introdução
O efeito da analgesia regional nas complicações infecciosas perioperatórias permanece desconhecido. Portanto, testamos a hipótese de que um composto de infecções graves após cirurgia colorretal é menos comum em pacientes com analgesia regional do que naqueles que receberam analgesia intravenosa controlada pelo paciente (ACP-IV) com opiáceos.
Métodos
Pacientes submetidos a cirurgia colorretal eletiva com duração de uma hora ou mais sob anestesia geral no Cleveland Clinic Main Campus entre 2009 e 2015 foram incluídos nesta análise retrospectiva. As exposições foram definidas como analgesia pós-operatória regional com epidurais ou bloqueios do Plano Transverso do Abdome (PTA); ou ACP-IV apenas com opiáceos. O desfecho foi definido como um composto de infecções graves intra-hospitalares, incluindo abscesso intra-abdominal, abscesso pélvico, infecção de sítio cirúrgico (ISC) profunda ou em órgão-espaço, clostridium difficile, pneumonia ou sepse. O modelo de regressão logística ajustado para os potenciais fatores de confusão desequilibrados entre o subconjunto de cirurgias combinadas foi usado para relatar as razões de chances junto com limites de confiança de 95%. O critério de significância foi p < 0,05.
Resultados
Um total de 7.811 pacientes preencheram os critérios de inclusão e exclusão, dos quais combinamos com sucesso 681 pacientes com anestesia regional a 2.862 pacientes apenas com ACP-IV com base em escores de propensão derivados de possíveis fatores de confusão. Houve 82 (12%) infecções pós-operatórias graves no hospital no grupo de analgesia regional versus 285 (10%) em pacientes ACP-IV. A analgesia regional não foi significativamente associada a infecção grave (odds ratio: 1,14; intervalo de confiança de 95% 0,87‒1,49; valor p = 0,339) após ajuste para duração cirúrgica e volume de cristaloides intraoperatórios.
Conclusão
A analgesia regional não deve ser selecionada como técnica analgésica pós-operatória para reduzir infecções.
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