The effect of thoracic epidural analgesia on short-term outcome and mortality in geriatric patients undergoing open heart surgery

BACKGROUND: In open-heart surgeries, many organ functions, particularly the respiratory system, are affected by post-operative pain, and so is mortality. Following open-heart surgery, geriatric patients have a higher risk of organ dysfunction and mortality. We aimed to compare the short-term outcomes and mortality of thoracic epidural analgesia (TEA) and intravenous (IV) analgesia in geriatric patients undergoing open heart surgery. METHODS: This study included patients over the age of 65 who had open-heart surgery between 2010 and 2020. The patients were divided into two groups: Those who received TEA (Group E) and those who received IV paracetamol or tramadol or dexmedetomidine (Group I). The patients’ post-operative sedation and analgesia requirements, mechanical ventilation (MV) duration, blood glucose levels, liver and kidney function tests, complications, intensive care and hospital stay lengths, and mortality rates were all compared. RESULTS: The study included a total of 548 patients, with 408 in Group E and 140 in Group I. As a result of the comparisons between the groups, sedation requirement, analgesia requirement, MV duration, post-extubation facial mask oxygen requirement, non-invasive MV need, re-intubation requirement, and blood glucose level were found to be lower in Group E than in Group I. Moreover, periods spent in intensive care and lengths of hospital stay were found to be lower in Group E than Group I. There was no difference found between the two groups in terms of hospital mortality. CONCLUSION: In elderly patients undergoing open-heart surgery, TEA reduced the length of time in intensive care and hospital stays by improving the respiratory status and blood glucose regulation by supplying analgesia and sedation.