Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California.
University of California San Francisco, Section of Endocrine Surgery, San Francisco, California.
J Surg Res. 2019 Aug;240:236-240. doi: 10.1016/j.jss.2019.03.016. Epub 2019 Apr 17.
New persistent opioid use has been identified following minor surgical procedures and may contribute to the national opioid epidemic. Prescription patterns vary and we have limited data on patient pain experiences in the outpatient setting. We devised a novel short messaging service survey to record pain scores and opioid use following outpatient thyroid or parathyroid surgery.
Automated short messaging service was sent daily starting the evening of the operation until postoperative day (POD) 10. Pain was assessed on a 0-10 numeric pain rating scale and opioid use over the prior 24 h was queried.
A total of 1264 survey questions were sent with overall response rate of 84.3%. Fifty-three of 58 patients had a response rate >50% and were included in the final analysis. Average pain score was highest on POD1 at 3.2. Overall, 42.5% of patients utilized opioids on POD0, 55.6% on POD1, and steadily decreased to 7% by POD10. Overall, 34% of patients did not utilize any opioids postoperatively. Scaled total pain scores were higher in patients with thyroid surgery (23.5 versus 12.1, P = 0.02) and lower in those who reported alcohol use (14.9 versus 31.6, P < 0.02). Scaled total opioid days were lower in those aged >60 (1.5 versus 3.6, P < 0.01) and higher in those with active tobacco use (4.5 versus 2.3, P = 0.04). Pain scores correlated weakly with total opioid days (r = 0.32).
We demonstrate a novel approach of obtaining patient reported daily, prospective pain scores. This may help us understand patient pain and opioid use in the acute postoperative period especially following outpatient surgery.
在进行小型外科手术后，新出现了持续的阿片类药物使用情况，这可能导致了全国性的阿片类药物泛滥。处方模式存在差异，我们对外科门诊患者的疼痛体验数据有限。我们设计了一种新颖的短消息服务调查，以记录门诊甲状腺或甲状旁腺手术后的疼痛评分和阿片类药物使用情况。
手术当晚开始，每天通过自动短消息服务发送，直至术后第 10 天。疼痛使用 0-10 的数字疼痛评分量表进行评估，并询问过去 24 小时内的阿片类药物使用情况。
共发送了 1264 个调查问题，总体回复率为 84.3%。58 例患者中有 53 例的回复率>50%，并纳入最终分析。平均疼痛评分在术后第 1 天最高，为 3.2。总体而言，42.5%的患者在术后第 0 天使用阿片类药物，55.6%在术后第 1 天，术后第 10 天稳定下降至 7%。总体而言，34%的患者术后未使用任何阿片类药物。甲状腺手术后患者的总疼痛评分较高（23.5 比 12.1，P=0.02），而报告饮酒的患者评分较低（14.9 比 31.6，P<0.02）。>60 岁的患者使用总阿片类药物天数较少（1.5 比 3.6，P<0.01），而有主动吸烟的患者使用天数较多（4.5 比 2.3，P=0.04）。疼痛评分与总阿片类药物天数呈弱相关（r=0.32）。
我们展示了一种新颖的获取患者每日前瞻性疼痛评分的方法。这可能有助于我们了解术后患者的疼痛和阿片类药物使用情况，尤其是在门诊手术后。
