Impact of remifentanil use on early postoperative outcomes following brain tumor resection or rectal cancer surgery

Kanji Uchida, Hideo Yasunaga, Hiroaki Miyata, Masahiko Sumitani, Hiromasa Horiguchi, Shinya Matsuda, Yoshitsugu Yamada

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Purpose: Remifentanil, a mu-opioid receptor agonist, has important characteristics for neuroanesthesia, but data about its effects on postoperative recovery and mortality are currently lacking. Methods: Using the Japanese Diagnosis Procedure Combination database in 2007, we selected patients who underwent elective brain tumor resection with open craniotomy under general anesthesia using either remifentanil or fentanyl and divided them into two categories: remifentanil patients and non-remifentanil patients. After propensity score matching for potential confounders, we compared the in-hospital mortality and postoperative length of stay (LOS) between the two groups. For comparison, the same endpoints were evaluated for patients underwent rectal cancer surgery under general anesthesia with intraoperative epidural anesthesia. Results: In patients who underwent brain tumor resection (936 pairs), remifentanil patients had significantly lower in-hospital mortality (1.5 % vs. 3.0 %; P = 0.029). Logistic regression analysis revealed that the odds ratio for use of remifentanil for in-hospital mortality was 0.47 (95 % confidence interval, 0.25-0.91; P = 0.025). Remifentanil patients also showed earlier discharge from hospital (median LOS, 17 vs. 19 days; hazard ratio, 1.19, 95 % confidence interval, 1.08-1.30; P < 0.001). In contrast, in 2,756 pairs of patients undergoing rectal cancer surgery, no significant difference was seen in either in-hospital morality (1.2 % vs. 1.3 %; P = 0.518) or median LOS (19 vs. 19 days; P = 0.148) between the two groups. Conclusions: Our data suggest a possible association between use of remifentanil and better early postoperative recovery for patients undergoing neurosurgery with craniotomy. Further studies, including a randomized controlled trial, are required to confirm the present results.

Original languageEnglish
Pages (from-to)711-720
Number of pages10
JournalJournal of Anesthesia
Volume26
Issue number5
DOIs
Publication statusPublished - 2012 Oct
Externally publishedYes

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Rectal Neoplasms
Brain Neoplasms
Hospital Mortality
Length of Stay
Craniotomy
General Anesthesia
Confidence Intervals
remifentanil
Propensity Score
mu Opioid Receptor
Epidural Anesthesia
Neurosurgery
Fentanyl
Randomized Controlled Trials
Logistic Models
Odds Ratio
Regression Analysis
Databases
Mortality

Keywords

  • Brain neoplasm
  • Neurosurgery
  • Postoperative outcome
  • Remifentanil

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Impact of remifentanil use on early postoperative outcomes following brain tumor resection or rectal cancer surgery. / Uchida, Kanji; Yasunaga, Hideo; Miyata, Hiroaki; Sumitani, Masahiko; Horiguchi, Hiromasa; Matsuda, Shinya; Yamada, Yoshitsugu.

In: Journal of Anesthesia, Vol. 26, No. 5, 10.2012, p. 711-720.

Research output: Contribution to journalArticle

Uchida, Kanji ; Yasunaga, Hideo ; Miyata, Hiroaki ; Sumitani, Masahiko ; Horiguchi, Hiromasa ; Matsuda, Shinya ; Yamada, Yoshitsugu. / Impact of remifentanil use on early postoperative outcomes following brain tumor resection or rectal cancer surgery. In: Journal of Anesthesia. 2012 ; Vol. 26, No. 5. pp. 711-720.
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AU - Uchida, Kanji

AU - Yasunaga, Hideo

AU - Miyata, Hiroaki

AU - Sumitani, Masahiko

AU - Horiguchi, Hiromasa

AU - Matsuda, Shinya

AU - Yamada, Yoshitsugu

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AB - Purpose: Remifentanil, a mu-opioid receptor agonist, has important characteristics for neuroanesthesia, but data about its effects on postoperative recovery and mortality are currently lacking. Methods: Using the Japanese Diagnosis Procedure Combination database in 2007, we selected patients who underwent elective brain tumor resection with open craniotomy under general anesthesia using either remifentanil or fentanyl and divided them into two categories: remifentanil patients and non-remifentanil patients. After propensity score matching for potential confounders, we compared the in-hospital mortality and postoperative length of stay (LOS) between the two groups. For comparison, the same endpoints were evaluated for patients underwent rectal cancer surgery under general anesthesia with intraoperative epidural anesthesia. Results: In patients who underwent brain tumor resection (936 pairs), remifentanil patients had significantly lower in-hospital mortality (1.5 % vs. 3.0 %; P = 0.029). Logistic regression analysis revealed that the odds ratio for use of remifentanil for in-hospital mortality was 0.47 (95 % confidence interval, 0.25-0.91; P = 0.025). Remifentanil patients also showed earlier discharge from hospital (median LOS, 17 vs. 19 days; hazard ratio, 1.19, 95 % confidence interval, 1.08-1.30; P < 0.001). In contrast, in 2,756 pairs of patients undergoing rectal cancer surgery, no significant difference was seen in either in-hospital morality (1.2 % vs. 1.3 %; P = 0.518) or median LOS (19 vs. 19 days; P = 0.148) between the two groups. Conclusions: Our data suggest a possible association between use of remifentanil and better early postoperative recovery for patients undergoing neurosurgery with craniotomy. Further studies, including a randomized controlled trial, are required to confirm the present results.

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KW - Neurosurgery

KW - Postoperative outcome

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