甲状腺和甲状旁腺手术中的阿片类药物处方实践和需求。
Opioid Prescribing Practice and Needs in Thyroid and Parathyroid Surgery.
机构信息
Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland.
Department of Surgery, Oregon Health and Science University, Portland.
出版信息
JAMA Otolaryngol Head Neck Surg. 2018 Dec 1;144(12):1098-1103. doi: 10.1001/jamaoto.2018.2427.
IMPORTANCE
In recent years, the medical community's inadvertent contribution to opioid addiction has been recognized.
OBJECTIVE
To determine the opioid prescribing practices and opioid needs for patients undergoing thyroid and parathyroid surgery to help reduce postoperative opioid administration.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included 1788 opioid-naive patients who underwent thyroid and parathyroid surgery from January 1, 2012, through December 31, 2017, at the high-volume academic endocrine surgery center at Oregon Health and Sciences University. Patients with long-term opioid treatment and those who underwent other head and neck procedures or robotic thyroidectomy were excluded. For analysis, 1765 procedures were available (723 parathyroidectomy, 400 hemithyroidectomy, and 642 total thyroidectomy).
MAIN OUTCOMES AND MEASURES
The quantity of prescribed opioids was determined in morphine milligram equivalents (MME). Opioid refill data after discharge were also analyzed. Patients were then divided into past (1336 in group 1 [January 1, 2012, to September 30, 2016]) and current (429 in group 2 [October 31, 2016, to December 31, 2017]) prescribing practices. For each procedure, the mean quantity prescribed for each group, difference between the means, 95% CI for the difference, and effect size were calculated.
RESULTS
A total of 1702 patients (80.0% female [n = 1361]; mean age, 51.2 years [range, 7-97 years]) undergoing 1765 procedures were included in the analysis. For parathyroidectomy, the mean (SD) opioid quantity prescribed was 176.20 (86.66) MME in group 1 vs 80.08 (74.43) MME in group 2 (effect size, 1.139); for hemithyroidectomy, 204.65 (112.24) MME in group 1 vs 112.24 (102.31) MME in group 2 (effect size, 0.842); and for total thyroidectomy, 214.87 (161.09) MME for group 1 vs 102.29 (87.72) MME for group 2 (effect size, 0.754). In the last quarter of 2017, the numbers of patients discharged without any opioid prescription were 15 of 26 (57.5%) for parathyroidectomy, 12 of 32 (37.5%) for hemithyroidectomy, and 9 of 27 (33.3%) for total thyroidectomy. Patient calls requesting pain medications for group 2 were similar or fewer, depending on the procedure. Those who were prescribed less than 75.0 MME postoperatively did not call for additional opioid prescriptions.
CONCLUSIONS AND RELEVANCE
Our study suggests that patients undergoing thyroid and parathyroid surgery need little, if any, postoperative opioids.
重要性
近年来，医学界无意中促成了阿片类药物成瘾这一现象，这一点已经得到了认识。
目的
确定甲状腺和甲状旁腺手术患者的阿片类药物处方实践和阿片类药物需求，以帮助减少术后阿片类药物的使用。
设计、地点和参与者：这是一项回顾性队列研究，纳入了 2012 年 1 月 1 日至 2017 年 12 月 31 日期间在俄勒冈健康与科学大学高容量学术内分泌外科中心接受甲状腺和甲状旁腺手术的 1788 例阿片类药物初治患者。排除长期接受阿片类药物治疗和接受其他头颈部手术或机器人甲状腺切除术的患者。分析中，1765 例手术可用（723 例甲状旁腺切除术、400 例甲状腺半切除术和 642 例甲状腺全切除术）。
主要结果和测量
以吗啡毫克当量（MME）来确定开处的阿片类药物数量。还分析了出院后的阿片类药物再开情况。然后将患者分为过去（第 1 组，1336 例[2012 年 1 月 1 日至 2016 年 9 月 30 日]）和当前（第 2 组，429 例[2016 年 10 月 31 日至 2017 年 12 月 31 日]）两种处方实践。对于每种手术，计算每组的平均开处剂量、平均值差异、差异的 95%置信区间和效应量。
结果
共纳入 1702 例患者（80.0%为女性[n=1361]；平均年龄 51.2 岁[范围：7-97 岁]），共进行了 1765 例手术。甲状旁腺切除术的组 1 中位数（SD）开处阿片类药物数量为 176.20（86.66）MME，组 2 为 80.08（74.43）MME（效应量，1.139）；甲状腺半切除术的组 1 中位数（SD）开处阿片类药物数量为 204.65（112.24）MME，组 2 为 112.24（102.31）MME（效应量，0.842）；甲状腺全切除术的组 1 中位数（SD）开处阿片类药物数量为 214.87（161.09）MME，组 2 为 102.29（87.72）MME（效应量，0.754）。在 2017 年最后一个季度，26 例甲状旁腺切除术患者中有 15 例（57.5%）、32 例甲状腺半切除术患者中有 12 例（37.5%）和 27 例甲状腺全切除术患者中有 9 例（33.3%）出院时没有开任何阿片类药物处方。第 2 组患者要求开止痛药的电话数量相似或更少，具体取决于手术类型。术后开处少于 75.0 MME 的患者没有要求额外开阿片类药物处方。
结论和相关性
我们的研究表明，甲状腺和甲状旁腺手术患者术后可能只需很少甚至不需要阿片类药物。
Zotero 插件