From the Division of Gynecologic Surgery and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
Female Pelvic Med Reconstr Surg. 2020 Sep;26(9):580-584. doi: 10.1097/SPV.0000000000000628.
The aim of this study was to evaluate postoperative pain scores, quantity of prescribed opioids at hospital discharge, and need for additional opioid prescriptions among women undergoing surgical treatment of pelvic organ prolapse.
Institutional billing data were used to identify all patients undergoing pelvic reconstructive surgery between January 1, 2012, and May 30, 2017. Inpatient records were utilized to obtain prescription data (reported in oral morphine equivalents for standardization) and pain scores. The cohort was organized by surgical approach (open, endoscopic, vaginal), number of concomitant procedures, and patient age stratified by decade. These factors were then matched to postoperative pain scores, amount of opioid prescribed at discharge, and number of subsequent opioid refills. Pain scores and opioid use were also compared for correlation.
One thousand eight hundred thirty patients underwent surgical treatment of pelvic organ prolapse and met criteria for study participation. A significant decrease in pain scores, mean oral morphine equivalents prescribed, and opioid refill rates was seen with increasing patient age by decade regardless of surgical approach. Pain scores were significantly different only between patients undergoing vaginal surgery with 0 concomitant procedures versus 1 or more concomitant procedures. Finally, pain scores were directly correlated to the amount of opioid prescribed.
Pain scores, opioid prescription amounts, and refills varied by patient age and surgical approach but were unaffected by concomitant procedures. Further work in correlating pain scores to opioid utilization is needed to ensure appropriate prescribing patterns and reduce risks of opioid dependence and diversion.
本研究旨在评估行盆腔器官脱垂手术治疗的女性患者的术后疼痛评分、出院时开处的阿片类药物数量和对额外阿片类药物处方的需求。
利用机构计费数据确定了 2012 年 1 月 1 日至 2017 年 5 月 30 日期间行盆腔重建手术的所有患者。使用住院病历获取处方数据（标准化后以口服吗啡当量报告）和疼痛评分。该队列按手术方式（开腹、内镜、阴道）、同期手术数量和按十年为一阶段分层的患者年龄组织。然后将这些因素与术后疼痛评分、出院时开处的阿片类药物数量和随后的阿片类药物补充数量相匹配。还比较了疼痛评分和阿片类药物的使用情况，以评估相关性。
1830 名患者接受了盆腔器官脱垂的手术治疗，符合研究参与标准。无论手术方式如何，随着患者年龄每增加十年，疼痛评分、平均口服吗啡当量处方量和阿片类药物补充率均显著下降。仅在阴道手术中，0 个同期手术与 1 个或更多同期手术的患者之间的疼痛评分存在显著差异。最后，疼痛评分与开处的阿片类药物数量直接相关。
疼痛评分、阿片类药物处方量和补充量因患者年龄和手术方式而异，但与同期手术无关。需要进一步研究疼痛评分与阿片类药物使用之间的相关性，以确保合理的处方模式，并降低阿片类药物依赖和滥用的风险。
