Impact of remifentanil use on early postoperative outcomes following brain tumor resection or rectal cancer surgery
Journal of Anesthesia, 05/08/2012
Uchida K et al. – The data suggest a possible association between use of remifentanil and better early postoperative recovery for patients undergoing neurosurgery with craniotomy.Methods
- Using the Japanese Diagnosis Procedure Combination database in 2007, the authors selected patients who underwent elective brain tumor resection with open craniotomy under general anesthesia using either remifentanil or fentanyl and divided them into two categories: remifentanil patients and non-remifentanil patients.
- After propensity score matching for potential confounders, they compared the in-hospital mortality and postoperative length of stay (LOS) between the two groups.
- For comparison, the same endpoints were evaluated for patients underwent rectal cancer surgery under general anesthesia with intraoperative epidural anesthesia.
- In patients who underwent brain tumor resection (936 pairs), remifentanil patients had significantly lower in-hospital mortality (1.5 % vs. 3.0 %; P=0.029).
- Logistic regression analysis revealed that the odds ratio for use of remifentanil for in-hospital mortality was 0.47 (95 % confidence interval, 0.25–0.91; P=0.025).
- Remifentanil patients also showed earlier discharge from hospital (median LOS, 17 vs. 19 days; hazard ratio, 1.19, 95 % confidence interval, 1.08–1.30; P<0.001).
- In contrast, in 2,756 pairs of patients undergoing rectal cancer surgery, no significant difference was seen in either in-hospital morality (1.2 % vs. 1.3 %; P=0.518) or median LOS (19 vs. 19days; P=0.148) between the two groups.