Comparison of epidural anesthesia and intravenous self-control analgesia on postoperative recovery quality in duodenectomy

Figure 1 Pulmonary complications. Significantly lower rates across all categories for the epidural anesthesia group compared to the intravenous patient-controlled analgesia group: Overall complications: 11.9% vs 23.8% (^aP = 0.042); pneumonia: 4.8% vs 11.9% (^aP = 0.038); Atelectasis: 8.3% vs 17.9% (^aP = 0.022); pleural effusion: 7.1% vs 15.5% (^aP = 0.046); respiratory function parameters. Better outcomes in the epidural anesthesia group: Higher SpO₂ levels: 95.8% vs 93.6% (^aP < 0.001); better forced expiratory volume in 1 second values: 68.5% vs 52.4% of preoperative values (^aP < 0.001); shorter supplemental oxygen therapy: 1.6 days vs 2.8 days (^aP < 0.001); lower respiratory depression rates: 2.4% vs 6.0% (^aP = 0.246, not statistically significant). EA: Epidural anesthesia; IVPCA: Intravenous patient-controlled analgesia; FEV1: Forced expiratory volume in 1 second.

Figure 2 Receiver operating characteristic curve analysis. The receiver operating characteristic curve analysis demonstrated that 24-hour movement-evoked pain scores effectively predicted delayed hospital discharge (> 15 days) with good discriminatory ability (Area under the curve = 0.78, 95% confidence interval: 0.71-0.85, P < 0.001). A Visual Analog Scale pain score threshold of ≥ 5, with sensitivity of 76.3% and specificity of 72.9%, was identified as the optimal cutoff for predicting prolonged hospitalization, with significantly fewer epidural anesthesia patients exceeding this threshold compared to intravenous patient-controlled analgesia patients (18.7% vs 65.2%, P < 0.001). ROC: Receiver operating characteristic; AUC: Area under the curve.

Figure 3 Forest plot. A: Forest plot of predictors for favorable postoperative recovery. This forest plot illustrates independent predictors of favorable postoperative recovery, with epidural analgesia being the strongest positive predictor [adjusted odds ratios (OR) = 3.42] and American Society of Anesthesiologists physical status III being the most significant negative predictor (adjusted OR = 0.57). The visualization clearly distinguishes between factors promoting recovery (OR > 1) and those hindering recovery (OR < 1) through point estimates and 95% confidence intervals, effectively demonstrating the strength and statistical significance of each factor’s influence; B: Forest plot of epidural analgesia benefits by subgroup. The forest plot displays adjusted odds ratios with 95% confidence intervals for epidural analgesia benefits across different patient subgroups, revealing that elderly patients (age ≥ 70) derive the greatest benefit (odds ratios = 3.75) while younger patients and those with normal body mass index show more modest yet still significant improvements. This visualization effectively demonstrates that epidural analgesia provides statistically significant advantages for optimal recovery across all analyzed subgroups, with particularly pronounced benefits in high-risk populations, including those with pre-existing pulmonary disease, obesity, and diabetes mellitus. OR: Odds ratios; CI: Confidence interval.