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According to a recent study, which of the following types of surgery was MOST likely associated with a shorter hospital length of stay in patients who received epidural analgesia compared with those who did not?
(A) Thoracic X
(B) Vascular X
(C) Abdominal ✔
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The length of hospitalization has a serious impact on both patient morbidity and the economic viability of the institution. As such, there is tremendous pressure to develop clinical pathways to expedite postoperative patient recovery. Pain following surgery has always been a major barrier for discharge, with epidural analgesia considered to be the historical standard following open thoracic and abdominal surgeries. However, more recently, this technique has fallen out of favor due to side effects associated with epidural placement, which are perceived to lengthen the duration of hospitalization. The aim of a recent study was to examine the relationship between epidural analgesia and hospital length of stay across various surgery types.
In this single-institution, retrospective cohort study, data were collected from March 2019 to June 2023 on all patients who underwent elective open thoracic, vascular, or abdominal surgery and had no contraindications for thoracic epidural catheter placement. Patients were subdivided into 2 groups: those who received epidural analgesia and those who did not. For the epidural group, the acute pain medicine service used fluoroscopic guidance for preoperative placement of the catheter and followed postoperatively until the patient was successfully transitioned to oral-based analgesics. The standard epidural infusate solution used was 0.1% bupivacaine plus 2.5 µg/mL of hydromorphone running at 6 mL/h with a patient-controlled bolus of 3 mL every 20 minutes. For the group that did not receive an epidural, single-injection peripheral nerve blocks were performed (either by the regional nerve block team or the surgeon) and postoperative pain was managed entirely by the surgical service. The primary end point was hospital length of stay. Secondary end points included escalation in care postoperatively, readmission rates within 30 days of discharge, and reasons for lack of epidural placement.
Of the 1,874 patients assessed for eligibility, 1,747 completed follow-up analysis (n = 1,499 in the epidural group, n = 248 in the no-epidural group). Demographic information was similar between groups, with the no-epidural group having proportionally higher American Society of Anesthesiologists Physical Status scores. Denial due to surgeon preference (47.2%) was the leading reason why epidural catheter placement was not performed.
Median length of stay between the epidural group (6.2 days) and the no-epidural group (6.3 days) was not found to be different. However, when stratified by type of surgery, the median length of stay was 1.4 days shorter in the epidural group for abdominal surgery, while it was 3.2 days longer in the epidural group for thoracic surgery. No differences between the epidural and no-epidural groups were found for vascular surgery. This remained true, even after adjusting for covariates. Additionally, epidural analgesia reduced the risk of 30-day readmissions by 37% among patients undergoing abdominal surgery (odds ratio, 0.63; 95% CI, 0.41–0.97).
In summary, a recent study demonstrated that fluoroscopically placed thoracic epidural analgesia that is managed by an acute pain service was associated with a shorter hospital length of stay following open abdominal surgery. This reduction in length of stay was not observed in patients undergoing open vascular or thoracic surgery.
References
Date of last update: June 26, 2026
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