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La asociación entre analgesia epidural y mortalidad en cirugía abdominal de emergencia: un estudio de cohorte poblacional

REVISTA

Descripción: En pacientes sometidos a cirugía abdominal de emergencia se encontró que el uso de analgesia epidural perioperatoria estaba asociado con una disminución del riesgo de mortalidad

TITULO FUENTE ORIGINAL:

The association between epidural analgesia and mortality in emergency abdominal surgery: A population‐based cohort study

AUTORES:

Morten Vester-Andersen, Lars Hyldborg Lundstrøm, Morten Hylander Møller, Danish Anaesthesia Database

REVISTA ABREV.:

Acta Anaesthesiol Scand

AÑO:

2020

REFERENCIA:

64(1):104-111

DOI:

10.1111/aas.13461

RESUMEN ORIGINAL:

Background: Emergency abdominal surgery carries a considerable risk of mortality and post-operative complications, including pulmonary complications. In major elective surgery, epidural analgesia reduces mortality and pulmonary complications. We aimed to evaluate the association between epidural analgesia and mortality in emergency abdominal surgery. Methods: In this population-based... + Leer más

Background: Emergency abdominal surgery carries a considerable risk of mortality and post-operative complications, including pulmonary complications. In major elective surgery, epidural analgesia reduces mortality and pulmonary complications. We aimed to evaluate the association between epidural analgesia and mortality in emergency abdominal surgery.

Methods: In this population-based cohort study with prospective data collection, we included adults undergoing emergency abdominal laparotomy or laparoscopy between 1 January 2009 and 31 December 2010 at 13 Danish hospitals. Appendectomies were excluded. The primary outcome was 90-day mortality. Secondary outcomes included 30-day mortality and serious adverse events. We used binary logistic regression analyses (odds ratios (ORs) with 95% confidence intervals (CIs)).

Results: We included 4920 patients, of whom 1134 (23.0%) died within 90 days. Overall, 27.9% of the patients were treated with epidural analgesia perioperatively. This increased to 34.0% among patients undergoing major laparotomy. The crude and adjusted association between epidural analgesia and 90-day mortality was OR 0.99 (95%CI: 0.86-1.15, P = .94) and OR 0.80 (95%CI: 0.67-0.94; P = .01), respectively. For 30-day mortality the corresponding estimates were OR 0.90 (95% CI: 0.76-1.06, P = .21) and OR 0.75 (95% CI: 0.62-0.90, P < .01), respectively. No serious adverse events were reported.

Conclusion: In this population-based cohort study of adult patients undergoing emergency abdominal surgery, we found that the use of epidural analgesia perioperatively was associated with a decreased risk of mortality in the adjusted analysis

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