Effect of postoperative epidural analgesia on morbidity
and mortality after lung resection in Medicare patients
Christopher L. Wu MD (Associate Professor)
Adam Sapirstein MD (Assistant Professor)
Robert Herbert (Research Associate)
Andrew J. Rowlingson BA (Research Associate)
Robert K. Michaels MD, MPH (Resident)
Michelle A. Petrovic MD (Resident)
Lee A. Fleisher MD (Professor and Chair)
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, MD 21287, USA
Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health,
The Johns Hopkins University, Baltimore, MD 21287, USA
Department of Anesthesia, University of Pennsylvania, Philadelphia, PA 19104, USA
Received 20 September 2005; revised 20 February 2006; accepted 9 March 2006
Study Objective: To perform an analysis of the Medicare claims database in patients undergoing
lung resection to determine whether there is an association between postoperative epidural analgesia
Design: Retrospective cohort (database) design.
Setting: University hospital.
Measurements: We examined a cohort of 3501 patients obtained from a 5% nationally random
sample of 1997 to 2001 Medicare beneficiaries who underwent nonemergency segmental excision of
the lung (International Classification of Diseases, 9th Revision, Clinical Modification codes 32.3 and
32.4). Patient data were divided into two groups depending on the presence or absence of billing for
postoperative epidural analgesia (Current Procedural Terminology code 01996). The primary
outcomes assessed were death at 7 and 30 days after the procedure. The rates of major morbidity
(acute myocardial infarction, angina, cardiac dysrhythmias, heart failure, pneumonia, pulmonary
edema, respiratory failure, deep venous thrombosis, pulmonary embolism, sepsis, acute renal failure,
somnolence, acute cerebrovascular event, transient organic syndrome, and paralytic ileus) were also
compared. Multivariate regression analysis incorporating race, gender, age, comorbidities, hospital
0952-8180/$ – see front matter D 2006 Elsevier Inc. All rights reserved.
Presented in part at the 29th annual meeting of the American Society of Regional Anesthesia, Orlando, FL, March 2004.
Supported by grants to Dr Wu from the American Society of Regional Anesthesia and Pain Medicine/Carl Koller Memorial Research Fund and the
Blaustein Pain Fund.
* Corresponding author. Tel: +1 410 614 0401; fax: +1 410 614 1796.
E-mail address: firstname.lastname@example.org (C.L. Wu).
Journal of Clinical Anesthesia (2006) 18, 515 – 520