Gan Tong J, Robinson Scott B, Oderda Gary M, Scranton Richard, Pepin Jodie, Ramamoorthy Sonia
Stony Brook University , Stony Brook, Long Island, NY , USA.
Curr Med Res Opin. 2015 Apr;31(4):677-86. doi: 10.1185/03007995.2015.1005833. Epub 2015 Feb 10.
To assess the incidence and economic impact of postoperative ileus (POI) following laparotomy (open) and laparoscopic procedures for colectomies and cholecystectomies in patients receiving postoperative pain management with opioids.
Using the Premier research database, we retrospectively identified adult inpatients discharged between 2008 and 2010 receiving postsurgical opioids following laparotomy and laparoscopic colectomy and cholecystectomy. POI was identified through ICD-9 diagnosis codes and postsurgical morphine equivalent dose (MED) determined.
A total of 138,068 patients met criteria, and 10.3% had an ileus. Ileus occurred more frequently in colectomy than cholecystectomy and more often when performed by laparotomy. Ileus patients receiving opioids had an increased length of stay (LOS) ranging from 4.8 to 5.7 days, total cost from $9945 to $13,055 and 30 day all-cause readmission rate of 2.3 to 5.3% higher compared to patients without ileus. Patients with ileus received significantly greater MED than those without (median: 285 vs. 95 mg, p < 0.0001) and were twice as likely to have POI. MED above the median in ileus patients was associated with an increase in LOS (3.8 to 7.1 days), total cost ($8458 to $19,562), and readmission in laparoscopic surgeries (4.8 to 5.2%). Readmission rates were similar in ileus patients undergoing open procedures regardless of MED.
Use of opioids in patients who develop ileus following abdominal surgeries is associated with prolonged hospitalization, greater costs, and increased readmissions. Furthermore, higher doses of opioids are associated with higher incidence of POI. Limitations are related to the retrospective design and the use of administrative data (including reliance on ICD-9 coding). Yet POI may not be coded and therefore underestimated in our study. Assessment of pre-existing disease and preoperative pain management was not assessed. Despite these limitations, strategies to reduce opioid consumption may improve healthcare outcomes and reduce the associated economic impact.
评估接受阿片类药物术后疼痛管理的患者在开腹和腹腔镜结肠切除术及胆囊切除术后发生术后肠梗阻（POI）的发生率及经济影响。
利用Premier研究数据库，我们回顾性识别了2008年至2010年间接受开腹及腹腔镜结肠切除术和胆囊切除术后使用术后阿片类药物的成年住院患者。通过ICD - 9诊断编码识别POI，并确定术后吗啡等效剂量（MED）。
共有138,068名患者符合标准，其中10.3%发生了肠梗阻。肠梗阻在结肠切除术中比在胆囊切除术中更频繁发生，且开腹手术时更常发生。与未发生肠梗阻的患者相比，发生肠梗阻且接受阿片类药物治疗的患者住院时间延长（4.8至5.7天），总费用从9945美元至13,055美元不等，30天全因再入院率高2.3%至5.3%。发生肠梗阻的患者接受的MED显著高于未发生肠梗阻的患者（中位数：285 vs. 95毫克，p < 0.0001），且发生POI的可能性是未发生肠梗阻患者的两倍。肠梗阻患者中MED高于中位数与腹腔镜手术住院时间延长（3.8至7.1天）、总费用（8458美元至19,562美元）及再入院率增加（4.8%至5.2%）相关。无论MED如何，接受开腹手术的肠梗阻患者再入院率相似。
腹部手术后发生肠梗阻的患者使用阿片类药物与住院时间延长、费用增加及再入院率升高相关。此外，更高剂量的阿片类药物与POI发生率更高相关。局限性与回顾性设计及行政数据的使用（包括对ICD - 9编码的依赖）有关。然而，POI在我们的研究中可能未被编码，因此被低估。未评估既往疾病及术前疼痛管理情况。尽管存在这些局限性，但减少阿片类药物消耗的策略可能改善医疗保健结局并降低相关经济影响。
