Lou Irene, Chennell Todd B, Schaefer Sarah C, Chen Herbert, Sippel Rebecca S, Balentine Courtney, Schneider David F, Moalem Jacob
Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.
Department of Surgery, University of Rochester, Rochester, NY, USA.
Ann Surg Oncol. 2017 Jul;24(7):1951-1957. doi: 10.1245/s10434-017-5781-y. Epub 2017 Feb 3.
Thyroidectomy and parathyroidectomy are the most commonly performed endocrine operations, and are increasingly being completed on a same-day basis; however, few data exist regarding the outpatient postoperative pain requirement of these patients. We aimed to describe the outpatient narcotic medication needs for patients undergoing thyroid and parathyroid surgery, and to identify predictors of higher requirement.
We examined patients undergoing thyroid and parathyroid surgery at two large academic institutions from 1 January-30 May 2014. Prospective data were collected on pain scores and the oral morphine equivalents (OMEQs) taken by these patients by their postoperative visit.
Overall, 313 adult patients underwent thyroidectomy or parathyroidectomy during the study period; 83% of patients took ten or fewer OMEQs, and 93% took 20 or fewer OMEQs. Patients who took more than ten OMEQs were younger (p < 0.001) and reported significantly higher overall mean pain scores at their postoperative visit (p < 0.001) than patients who took fewer than ten OMEQs. A multivariate model was constructed on pre- and intraoperative factors that may predict use of more than ten OMEQs postoperatively. Age <45 years (p = 0.002), previous narcotic use (p = 0.037), and whether parathyroid or thyroid surgery was performed (p = 0.003) independently predicted the use of more than ten OMEQs after surgery. A subgroup analysis was then performed on thyroidectomy-only patients.
Overall, 93% of patients undergoing thyroidectomy and parathyroidectomy require 20 or fewer OMEQs by their postoperative visit. We therefore recommend these patients be discharged with 20 OMEQs, both to minimize waste and increase patient safety.
甲状腺切除术和甲状旁腺切除术是最常开展的内分泌手术，并且越来越多地在同一天完成；然而，关于这些患者门诊术后疼痛用药需求的数据很少。我们旨在描述接受甲状腺和甲状旁腺手术患者的门诊麻醉药物需求，并确定更高需求的预测因素。
我们研究了2014年1月1日至5月30日在两家大型学术机构接受甲状腺和甲状旁腺手术的患者。前瞻性收集了这些患者术后复诊时的疼痛评分和口服吗啡当量（OMEQ）。
总体而言，在研究期间有313例成年患者接受了甲状腺切除术或甲状旁腺切除术；83%的患者服用的OMEQ为10个或更少，93%的患者服用的OMEQ为20个或更少。服用超过10个OMEQ的患者比服用少于10个OMEQ的患者更年轻（p<0.001），并且在术后复诊时报告的总体平均疼痛评分显著更高（p<0.001）。构建了一个多变量模型，基于术前和术中因素来预测术后使用超过10个OMEQ的情况。年龄<45岁（p=0.002）、既往使用麻醉药物（p=0.037）以及是否进行了甲状旁腺或甲状腺手术（p=0.003）独立预测术后使用超过10个OMEQ的情况。然后对仅接受甲状腺切除术的患者进行了亚组分析。
总体而言，93%的接受甲状腺切除术和甲状旁腺切除术的患者在术后复诊时需要20个或更少的OMEQ。因此，我们建议为这些患者开具20个OMEQ的药物出院，既能减少浪费又能提高患者安全性。
