Association between Thoracic epidural anesthesia and postoperative complications in Neoadjuvant chemotherapy patients: a propensity score-matching study

Background Thoracic epidural anesthesia (TEA) combined with general anaesthesia (GA) leads to favorable outcomes after surgery. Whether this anesthetic technique is appropriate for patients undergoing neoadjuvant chemotherapy (NACT) remains unclear. This retrospective study aimed to compare the effect of TEA combined with GA versus GA alone on postoperative complications in NACT patients. Methods Patients who underwent NACT before elective gastric or colorectal surgery were included from January 1, 2020, to December 31, 2022. Using propensity score matching (PSM), patients who received TEA combined with GA were compared to those who received GA alone. The primary outcome was the incidence of postoperative complications, whereas the secondary outcomes included intraoperative hypotension, hospital respiratory complications, hospital gastrointestinal complications, length of postoperative hospital stay, and in-hospital mortality. Inverse probability of treatment weighting (IPTW) adjustment, overlap weighting (OW) adjustment, and multivariable logistic regression were performed to further evaluate the primary outcome. Results A total of 365 patients included, 152 patients underwent TEA combined with GA, and 213 patients underwent GA alone. After 1:1 PSM, 113 patients were included in each group. Among NACT patients, compared with the GA group, the incidence of postoperative complications was significantly higher in the TEA + GA group after IPTW (26.1% vs 13.0%, OR [95% CI]: 2.37 [1.18 to 4.73], p = 0.015) and OW (25.6% vs 12.4%, OR [95% CI]: 2.43 [1.34 to 4.39], p = 0.003) adjustment. However, after PSM, the difference in postoperative complications between the two groups was not statistically significant. For subgroup analysis, TEA combined with GA use was an independent risk factor for postoperative complications (OR [95%CI], 1.82 [1.07, 3.10], p = 0.026). Additionally, TEA combined with GA was associated with a higher incidence of intraoperative hypotension (42.5% vs 13.3%, OR [95% CI]: 4.83 [2.47 to 9.07], p < 0.000) and prolonged postoperative hospital stay (7 vs. 6 days, difference [95% CI]: 1 [0 to 1] day, p = 0.001) after adjustment via PSM. Conclusion TEA combined with GA is associated with an increased incidence of postoperative complications in NACT patients undergoing gastrointestinal surgery, as well as a higher rate of intraoperative hypotension and prolonged hospital stay than GA alone.