POSTOPERATIVE ANALGESIA REDUCES MORTALITY AND MORBIDITY AFTER ESOPHAGECTOMY

BACKGROUND: To study the influence of postoperative analgesia on morbi dity and mortality after esophagectomy. METHODS: The outcomes of 578 p atients who underwent one-stage resection between 1986 and 1995 were a nalyzed, Patients who received either epidural morphine, patient-contr olled analgesia, or continuous intravenous morphine infusion supervise d by an anesthesiology-based acute pain service (group APS, n = 299) w ere compared with those for whom conventional intramuscular meperidine injections were used (group CON, n = 279). RESULTS: Far patients who underwent transthoracic esophagectomy, group APS (n = 226) had a lower incidence of pulmonary complications (13% versus 25%, P = 0.002), car diovascular complications (21% versus 43%, P < 0.001), and hospital mo rtality (8% versus 14%, P = 0.038) when compared with group CON (n = 1 89). No similar difference was demonstrated in patients who underwent esophagectomy without thoracotomy. The hospital stay (days) was shorte r in group APS than in group CON for both transthoracic esophagectomy (22 +/- 20 versus 30 +/- 37, P = 0.005) and nontransthoracic esophagec tomy patients (19 +/- 13 versus 25 +/- 21, P = 0.029). CONCLUSION: Ade quate postoperative analgesia is associated with lower cardiopulmonary complications, lower mortality and reduced cost in patients undergoin g transthoracic esophagectomy. (C) 1997 by Excerpta Medica, Inc.