Presentation Authors: Brady L. Miller*, E. Jason Abel, Glenn O. Allen, Jessica R. Schumacher, David F. Jarrard, Tracy M. Downs, Kyle A. Richards, Madison, WI
Introduction: Epidural anesthesia is used to improve pain control after major surgery and has been associated with improved survival in some non-urologic cancers. Perioperative epidural use may reduce recurrence of non-muscle invasive bladder cancer. However, few data describe the impact of epidural use for bladder cancer patients treated with radical cystectomy. Here, we evaluate epidural use on perioperative and long-term outcomes for patients treated with radical cystectomy for bladder cancer.
Methods: Patients who received radical cystectomy for non-metastatic bladder urothelial carcinoma with epidural (n=1,748) and without epidural (n=6,109) anesthesia from 2002-2014 were identified using Surveillance, Epidemiology and End Results-Medicare data. Radical cystectomy outcomes with and without epidural anesthesia were compared using propensity score weighting.
Results: Epidural use at time of radical cystectomy was identified in 1,748 (22.2%) of 7,857 patients who met inclusion criteria. After propensity score weighted adjustment, epidural use was associated with increased 30-day readmission (29.6% vs. 26.2%, p < 0.001), increased median length of stay in days (9.0, IQR 7.0-12.0 vs 8.0, IQR 6.0-12.0, p < 0.01), and decreased likelihood of being discharged directly tohome without need for home health or skilled nursing care (21.6% vs 29.1%, p < 0.001). Post operative MI (2.6% vs 1.3%, p < 0.001) and stroke (4.7% vs 3.9%, p=0.028 in the first 30 days after radical cystectomy was more common in the epidural group, but perioperative 30-day mortality was similar (3.3% vs 2.9%, p=0.205). Epidural use was not associated with increased cancer specific (HR 0.96, 0.90-1.02, p=0.20) or overall survival (HR 0.99, 0.95-1.04, p=0.73).
Conclusions: Epidural use at time of radical cystectomy is associated with increased risk of perioperative complications, hospital readmission, and longer hospitalization without improving disease specific survival.