Comparison of Short-Term Postoperative Outcomes Following Open Aortofemoral Bypass With and Without Epidural Analgesia

BackgroundOpen aortofemoral bypass remains an established revascularization procedure for extensive aortoiliac occlusive disease.Although epidural analgesia can improve postoperative pain control after open abdominal aortic surgery, its association with short-term outcomes specifically following aortofemoral bypass for occlusive disease remains insufficiently characterized.We aimed to compare 30-day postoperative composite morbidity and selected recovery outcomes between patients receiving general anesthesia with thoracic epidural analgesia and those receiving general anesthesia with systemic opioid analgesia alone after elective open aortofemoral bypass. MethodsThis retrospective comparative observational study included 120 patients undergoing elective open aortofemoral bypass for aortoiliac occlusive disease at Bangladesh Medical University, Bangladesh, between January 2021 and December 2024.Patients were classified according to the analgesic technique documented in their medical records: epidural analgesia (Group E, n=60) or systemic opioid analgesia (Group G, n=60).The primary outcome was the occurrence of at least one postoperative complication within 30 days.Secondary outcomes included postoperative pain scores, pulmonary complications, mechanical ventilation duration, time to ambulation, time to oral feeding, intensive care unit (ICU) stay, hospital stay, and 30-day mortality. ResultsBaseline demographic and clinical characteristics and intraoperative variables were comparable between the groups.Composite postoperative morbidity was significantly lower in Group E than in Group G (14/60 (23.3%) vs. 30/60 (50.0%); χ²=9.19,p=0.002).Pulmonary complications were also less frequent in Group E (7/60 (11.7%) vs. 17/60 (28.3%); χ²=5.21,p=0.023).At 24 hours, the mean visual analog scale pain score was lower in Group E than in Group G (3.2 ± 1.1 vs. 5.9 ± 1.5; p<0.001).Group E also had shorter ICU stays (2.3 ± 0.9 vs. 3.7 ± 1.4 days), hospital stays (8.6 ± 2.5 vs. 11.9 ± 3.7 days), mechanical ventilation durations (5.4 ± 2.1 vs. 9.1 ± 3.4 hours), times to ambulation (2.0 ± 0.8 vs. 3.4 ± 1.1 days), and oral feeding (1.8 ± 0.7 vs. 2.9 ± 1.0 days; all p<0.001).Myocardial infarction, arrhythmia, acute kidney injury, wound infection, reoperation, and 30-day mortality were numerically less frequent in Group E, but the between-group differences were not statistically significant. ConclusionEpidural analgesia was associated with lower observed composite morbidity, lower pain scores, and more favorable short-term recovery measures after open aortofemoral bypass.The retrospective, nonrandomized design and potential confounding by indication preclude causal conclusions.Prospective studies should evaluate comparative effectiveness, patient selection, and analgesia-related safety.