Comparison between the effects of epidural and intravenous patient‐controlled analgesia on postoperative disability‐free survival in patients undergoing thoracic and abdominal surgery: A post hoc analysis

Abstract

AbstractBackgroundThoracic epidural analgesia (TEA) and intravenous patient‐controlled analgesia (IV‐PCA) are widely used to mitigate immediate postoperative pain; however, their effects on long‐term disability‐free survival are poorly documented. This study aimed to compare the effects of postoperative TEA and IV‐PCA on disability‐free survival in patients who underwent thoracic or abdominal surgery.MethodsThis post hoc analysis of a prospective observational study included 845 inpatients aged ≥55 years that underwent elective thoracic and abdominal surgery between 1 April 2016 and 28 December 2018 in a tertiary care hospital. Inverse probability of treatment weighted (IPTW) using stabilized inverse propensity scores was adopted to minimize bias. The primary outcome in this study was disability‐free survival, defined as survival with a 12‐item World Health Organization Disability Assessment Schedule 2.0 score of <16%, assessed at 3 months and 1 year after surgery.ResultsThe final analysis included 601 patients who received TEA and 244 who received IV‐PCA. After IPTW, the weighted incidence of disability‐free survival at 3 months and 1 year was 60.5% and 61.4% in the TEA group and 78.3% and 66.2% in the IV‐PCA group, respectively. The adjusted OR for disability‐free survival at 3 months and 1 year was 0.84 (95% confidence interval [CI]: 0.50–1.39) and 1.21 (95% CI: 0.72–2.05), respectively, for the TEA group.ConclusionNo significant differences were observed in the disability‐free survival at 3 months and 1 year after elective thoracic and abdominal surgery in patients aged ≥55 years who received TEA or IV‐PCA.Significance statementThis study is the first in our setting to document the long‐term effects of patient‐controlled analgesia. In a post hoc analysis of our prospective cohort study, we show that although differences in chronic postsurgical pain exist at 3 months post‐surgery, disability‐free survival rates at 1 year do not differ irrespective of the choice of patient‐controlled analgesia. The findings of this study highlight the need for shared decision‐making between clinicians and patients.