Epidural Analgesia in Patients with Chronic Obstructive Pulmonary Disease Undergoing Transperitoneal Abdominal Aortic Aneurysmorraphy — A Multi-Institutional Analysis

Introduction: Patients with chronic obstructive pulmonary disease (COPD) are more likely to develop pulmonary morbidity following major abdominal surgery. The purpose of this study was to examine the utility of epidural analgesia in patients with COPD who underwent elective transperitoneal abdominal aortic aneurysm (AAA) repair. Methods: During a 7-year period, all patients diagnosed with COPD undergoing elective AAA repair (n=425) from three hospitals were reviewed. Inclusion criteria were an FEV₁/FVC ratio <75% and/or a PaCO₂>45 mmHg. Clinical outcomes were compared between those who received epidural analgesia (epidural group) and those who did not (control group). Primary endpoints measured were duration of intubation, ICU stay, hospital days, and pulmonary complications. Results: Strict inclusion criteria were met by 131 patients, which included 86 patients in the epidural group and 45 patients in the control group. When comparing the epidural vs. control group, the mean AAA size was 6.3±0.9 cm vs. 6.0±1.5 cm (NS), FEV₁ was 57.2±24.7% vs. 49.0±10.3% (NS), and the mean FEV₁/FVC ratio was 52.0±11.4% vs. 50.6±6.7% (NS), respectively. The epidural group had a significantly lower incidence of post-operative ventilator dependency and ICU stay (p<0.05), as well as a decreased trend in pulmonary complications when compared to the control group. The overall hospital stay remained similar between the two groups. The relative risk of developing a pulmonary complication in the absence of epidural analgesia was 2.3. Conclusions: Perioperative epidural analgesia is beneficial in patients with COPD undergoing AAA repair by reducing both the post-operative ventilator duration and ICU stay. Epidural analgesia should be considered in all COPD patients undergoing elective transperitoneal AAA repair.