Combined Epidural-General Anesthesia is Associated with Increased Postoperative Complications in Patients Receiving Neoadjuvant Chemotherapy Followed by Gastrointestinal Radical Surgery: A Propensity Score Weighting Study

Background Combined epidural-general anesthesia (TEA+GA) can enhance postoperative recovery after gastrointestinal surgery. However, in patients receiving preoperative neoadjuvant chemotherapy (NACT), a known risk factor for postoperative complications, it remains unclear whether TEA+GA improves postoperative outcomes.Methods This retrospective cohort study included 365 patients with NACT followed by radical resection of gastrointestinal cancer at Zhongshan Hospital between January 2020 and December 2022. TEA was initiated before the induction of GA. The primary outcome was the incidence of any postoperative in-hospital complications. Secondary outcomes included intraoperative sufentanil consumption, hypotension, vasopressor use, extubation time, post-anesthesia care unit stay, postoperative hospital length of stay, and intensive care unit admission. Inverse probability of treatment weighting (IPTW) and overlap weighting (OW) were applied to adjust for baseline differences.Results Of the 365 patients, 152 received TEA+GA, while 213 received GA alone. TEA+GA was associated with a significantly higher rate of postoperative complications (23.7% vs. 15.0%, OR [95% CI]: 1.76 (1.05–2.96), p = 0.036) without subgroup difference. This association remained significant after IPTW (24.1% vs 11.7%, OR [95% CI]: 2.39 [1.24–4.59], p = 0.009) and OW (23.3% vs 10.4%; OR [95% CI]: 2.62 [1.36–5.08], p = 0.004) adjustment. The TEA+GA group had a lower dose of intraoperative sufentanil use and shorter extubation times but showed a higher rate of intraoperative hypotension and increased vasopressor requirements.Conclusions In patients who underwent NACT followed by gastrointestinal radical surgery, Combined epidural-general anesthesia was associated with an increased incidence of postoperative in-hospital complications.