The use of thoracic epidural analgesia (TEA) in elective hepatopancreatobiliary (HPB) operations — which is considered “best practice” for pain control in such interventions — is associated with an increased risk of acquiring postoperative urinary tract infections (UTIs), according to a study published in HPB (Oxford).

Researchers retrospectively identified patients in the American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) database who underwent elective HPB operation between 2014 and 2016.

A total of 28,571 patients were included in the study. Of these, 5764 (20.2%) received TEA for HPB, whereas the other 22,807 (79.8%) patients did not receive epidural analgesia. The incidence of postoperative UTI comprised the primary outcome. The association between TEA and postoperative UTI was examined using multivariable logistic regression analysis.

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Approximately 2.4% (n=696) of patients in the cohort developed a UTI. The incidence of UTI was significantly higher among patients who received TEA compared with those who did not (3.5% vs 2.2%, respectively; P <.01). In the multivariable model, the use of TEA correlated with an increased risk of UTI (OR, 1.59; 95% CI, 1.35–1.89; P <.001).

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In an analysis adjusted for age and sex, increasing age >70 years was a strong predictor of UTI in men who received epidural analgesia (OR, 1.91; 95% CI, 1.41–2.59; P <.01). The incidence of UTI was also significantly associated with an increased sepsis risk (16.8% vs 5.6%; P <.001), increased length of hospital stay (9 vs 6 days; P <.001), and greater readmission rates (21.4% vs 12.3%; P <.001).

Limitations of the study included its retrospective nature as well as the lack of information on the use, duration and removal of indwelling urinary catheters, which could have contributed to UTI risk.

Concerning pain control strategies “for patients at increased risk of TEA-related adverse events,” the researchers suggested “more novel strategies, such as transversus abdominis muscle infiltration blocks with liposomal bupivacaine, can provide effective results, with lower morbidity and costs.”

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Patel S, Suz P, Powers BD, Anaya DA. Epidural analgesia for hepatopancreatobiliary operations and postoperative urinary tract infections: an unrecognized association of “best-practices” and adverse outcomes [published online May 12, 2020]. HPB (Oxford). 2020;S1365-182X(20)30140-30144