Postoperative epidural analgesia following abdominal aortic surgery: do the benefits justify the costs?

This study was undertaken to compare postoperative epidural analgesia (PEA) with patient-controlled analgesia (PCA) regarding complications, particularly pulmonary, death, intensive care unit and hospital stay, and hospital and physician charges. The elective consecutive infrarenal abdominal aortic procedures performed by two vascular surgeons over a 1 year period were retrospectively analyzed. Although nonrandomized, of the 80 patients reviewed, 40 received PEA and 40 received PCA. The following demographic data were obtained: age, sex, diabetes mellitus, hypertension, coronary artery disease, prior coronary revascularization, stroke, renal insufficiency, smoking, and chronic obstructive pulmonary disease. Epidural catheters were placed preoperatively and maintained for an average of 4 days postoperatively. All patients underwent routine aortic reconstruction via midline transperitoneal incisions. The demographics were similar in both groups. Likewise, surgical intensive care unit stay and complications were similar in both groups. The average length of stay in patients receiving PEA was 7.59 days, compared with 6.68 days for the PCA group. Following discharge from the hospital, no additional complications were encountered and no readmissions required during a 4-week follow-up. Average charge (hospital and physician) per patient for PEA was $2489.00 compared with $443.00 for patients receiving PCA (no physician charges generated for PCA). The results do not support the routine use of PEA following abdominal aortic operations. Savings are more than $2000.00 per patient for PCA compared with PEA.