Utilization and Outcomes of Epidural Anesthesia Versus Regional Anesthesia for Thoracic Surgery: An ACS-NSQIP Analysis

Objectives: To determine the use of epidural anesthesia compared with regional anesthesia as an adjunct to general anesthesia in thoracic surgery over time, and compare length of stay, overall morbidity, serious morbidity, and mortality between epidural and regional anesthesia when utilized as adjuncts to general anesthesia in thoracic surgery. Design: Retrospective data analysis from the American College of Surgeons National Surgical Quality Improvement Project data registry, years 2014 to 2022. Setting: Over 800 U.S. hospitals. Participants: Patients over 18 years of age undergoing thoracic surgery (N = 18,433). Interventions: Thoracic surgery with general anesthesia and either epidural or regional anesthesia adjuncts. Measurements and Main Results: Peripheral nerve block utilization increased over time, with a steady increase for patients undergoing lobectomy or pneumonectomy. In propensity score-weighted generalized linear models, patients receiving peripheral nerve blocks had shorter hospital stays relative to those receiving epidurals (3.91 days, 95% confidence interval [CI]: 3.83, 3.99 v 5.48 days, 95% CI: 5.40, 5.56, p < 0.001), lower odds of serious morbidity (odds ratio 0.81, 95% CI: 0.76, 0.86, p < 0.001), and lower odds of mortality (odds ratio 0.74, 95% CI: 0.59, 0.92, p = 0.008). Conclusions: The rate of peripheral nerve blocks in thoracic surgery increased over time. Patients receiving peripheral nerve blocks, relative to epidural anesthesia, had better outcomes. Future, adequately powered research is needed to evaluate whether findings remain consistent when accounting for other factors (eg, surgical approach, providers, institutions).