Patel SY, Ackerman RA, Boulware D, et al. - This study carried out a large national database from the National Surgical Quality Improvement Project (NSQIP) to investigate if postoperative complications may be influenced by the use of epidural anesthesia during radical cystectomy. Researchers obtained data from the 2014–2016 participant user files of the NSQIP database. They distinguished patients receiving radical cystectomy by CPT code and further stratified by anesthesia type. Univariable and multivariable analysis were applied to examine demographics, length of stay, and 30-day complications including death. This analysis enrolled a sum of 6,448 patients for analysis. Moreover, 5,064 patients received general anesthesia only and 1,384 patients received general and epidural anesthesia between 2014 and 2016. The evidence showed that with the use of epidural anesthesia, elderly patients (age > 75) undergoing radical cystectomy may experience more major complications. This may be due to end-organ impacts from the hemodynamic variations of epidural anesthesia which are poorly tolerated in the elderly population. Future single intervention epidural studies require to be conducted to isolate the impacts of epidural anesthesia on individual surgical procedures.