Epidural use at time of radical cystectomy (RC) is associated with an increased risk for myocardial infarction (MI) and other adverse perioperative outcomes, but does not impact disease-specific or overall survival, new study findings suggest.
A comparison of perioperative outcomes among patients who underwent RC with and without epidural anesthesia found that the epidural group, compared with the no-epidural group, had a significantly higher rate of MI in the first 30 days after RC (2.6% vs 1.3%) and 30-day readmission (29.6% vs 26.2%) after propensity score adjustment, Brady L Miller, MD, and colleagues at the University of Wisconsin in Madison reported in the American Journal of Clinical and Experimental Urology. The epidural group also had a significantly longer median length of stay (9 vs 8 days) and had a decreased likelihood of being discharged directly to home without need for home health or skilled nursing care (21.6% vs. 29.1%). The perioperative 30-day mortality rates did not differ significantly between the groups. Epidural use was not associated with increased cancer-specific or overall survival, according to the investigators.
Randomized controlled trials currently are examining the association between perioperative epidural use and survival outcomes among patients with melanoma and lung, breast, and colon cancer, none is ongoing for bladder cancer, Dr Brady’s team pointed out.
“Regardless, our results may inform current clinical bladder cancer guidelines, which generally lack evidence for epidural use, especially in era of prioritizing readmission reduction, improved quality and cost-containment,” the authors concluded.
The study included 7857 patients with non-metastatic bladder cancer identified using Surveillance, Epidemiology and End Results (SEER) and Medicare data. Of these patients, 1748 received an epidural and 6109 did not. Patients in both groups had a median age of 74 years.
Miller BL, Abel EJ, Allen G, et al. Trends in epidural anesthesia use at the time of radical cystectomy and its association with perioperative and survival outcomes: a population-based analysis. Am J Clin Exp Urol. 2020;8:28-37.