Epidural Analgesia for Gynecologic Oncology Patients Undergoing Laparotomy: A Retrospective Analysis and Systematic Review of Perioperative Outcomes

To investigate the impact of perioperative epidurals on postoperative pain, hospital length of stay (LOS), opioid use, and perioperative complications in gynecologic oncology patients undergoing laparotomy. We conducted a retrospective cohort study of patients undergoing laparotomy for a suspected or known gynecologic malignancy at a single tertiary cancer center using an enhanced recovery after surgery protocol without routine epidural analgesia use. Patients received either (1) epidural analgesia or (2) no regional analgesia. Propensity score matching was performed to adjust for confounding factors. Additionally, we conducted a systematic review and qualitative analysis. The primary outcome was postoperative pain. Secondary outcomes included LOS, opioid use, and postoperative complications. Of 530 patients meeting inclusion criteria, 20 (3.7%) received epidurals, and 510 (96.2%) did not. After propensity score matching, no differences in pain scores were observed. Patients with epidurals had a significantly longer LOS ( p = 0.016). No differences in total opioid use during admission ( p = 0.60) or complications within 30 days ( p = 0.40) were observed. Fifteen studies met inclusion criteria for the systematic review. Fourteen studies included pain scores, with eight noting improved pain control with epidural use. Two studies showed an increased LOS within epidural cohorts. Four studies exhibited higher rates of postoperative complications within epidural cohorts. Opioid use between cohorts was largely equivocal. Epidural analgesia was associated with an increased LOS. A systematic review suggests that perioperative epidurals are associated with increased postoperative complications and LOS. As inpatient hospital capacity is an important consideration among large health care systems where gynecologic oncologists practice, a critical evaluation of interventions that may impact postoperative patient discharge is needed.