Epidemiologic study of epidural analgesia for lung cancer surgery from 2011 to 2018 in South Korea: a National Health Insurance Database cohort study

BACKGROUND: Epidural analgesia is commonly used for pain control during lung cancer surgery. However, the clinical trends in epidural analgesia, associated factors, and their association with clinical outcomes remain controversial. Therefore, we aimed to investigate the trends, associated factors, and their association with the clinical outcomes of epidural analgesia for lung cancer surgery. METHODS: The National Health Insurance Database was used as the data source in a nationwide cohort study. All adult patients who underwent lung cancer surgery between 2011 and 2018 were included. RESULTS: A total of 60,031 adult patients who underwent surgery for lung cancer were included. Of these, a total of 24,786 patients (41.3%) received epidural analgesia with a mean value of 1.5 days (standard deviation: 2.0 days). Male sex, increased Charlson comorbidity index (CCI), concurrent musculoskeletal disease, and a wider surgical extent were associated with higher odds of epidural analgesia for lung cancer surgery. Compared to open thoracotomy, video-assisted thoracoscopic surgery (VATS) was associated with lower odds of epidural analgesia for lung cancer surgery. Moreover, epidural analgesia was not associated with 30-day mortality, fatal respiratory events, or one-year mortality after lung cancer surgery. CONCLUSIONS: From 2011 to 2018, 41.3% of patients with lung cancer in South Korea received epidural analgesia for lung cancer surgery. Some factors (male sex, increased CCI, concurrent musculoskeletal disease, wider surgical extent, and VATS) were associated with the use of epidural analgesia in lung cancer surgery. However, epidural analgesia was not associated with clinical outcomes after lung cancer surgery.