Obstetrics and Gynecology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
Obstetrics and Gynecology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA.
Int J Gynecol Cancer. 2019 Nov;29(9):1411-1416. doi: 10.1136/ijgc-2019-000508. Epub 2019 Aug 30.
Pre-operative opioid use is common and should be considered a comorbidity among surgical candidates. Our objective was to describe the rate of pre-operative opioid use and patterns of post-operative outpatient opioid prescribing in a cohort of gynecologic oncology patients.
A retrospective cohort study was conducted with 448 gynecologic oncology surgical patients undergoing surgery for a suspected or known cancer diagnosis from January 2016 to December 2016. Pre-operative opioid users (n=97) were identified. Patient and surgical characteristics were abstracted, as was post-operative opioid prescription (type of opioid, oral morphine equivalents amount) and length of stay. For pre-operative opioid users, the type of opioid prescribed post-operatively was compared with the type of pre-operative opioid. Pre-operative opioid users were compared with non-users, stratified by surgery type. Descriptive statistics were analyzed using χ statistic, and medians were compared using a Mann-Whitney U statistic.
Pre-operative opioid prescriptions were noted in 21% of patients, and 24% of these had two or more opioid prescriptions before surgery. The majority of pre-operative opioid users (51%) were maintained on the same agent post-operatively at the time of discharge, but 36% were switched to a different opioid and 7% were prescribed an additional opioid. Overall and in laparotomies, pre-operative opioid users received higher volume post-operative prescriptions than non-users. There was no difference in post-operative prescription volume for minimally invasive surgeries or in length of stay between pre-operative users and non-users.
Pre-operative opioid use is common in gynecologic oncology patients and should be considered during pre-operative planning. Pre-operative opioid use was associated with a higher volume and wider range of post-operative prescription. Over 40% of opioid users were discharged with either an additional opioid or a new opioid, highlighting a potential missed opportunity to optimize opioid safety. Further research is needed to characterize the relationship between pre-operative opioid use and peri-operative outcomes and to develop strategies to manage pain effectively in this population without compromising opioid safety.
术前使用阿片类药物较为常见，应将其视为手术患者的合并症之一。本研究旨在描述妇科肿瘤患者队列中术前使用阿片类药物的比例和术后门诊阿片类药物处方的模式。
对 2016 年 1 月至 2016 年 12 月期间因疑似或已知癌症诊断而接受手术的 448 名妇科肿瘤患者进行了回顾性队列研究。确定了术前使用阿片类药物的患者（n=97）。提取了患者和手术特征，以及术后阿片类药物处方（阿片类药物类型、口服吗啡等效物剂量）和住院时间。对于术前使用阿片类药物的患者，比较了术后开具的阿片类药物类型与术前使用的阿片类药物类型。按手术类型将术前使用阿片类药物的患者与未使用者进行分层比较。采用卡方检验进行描述性统计分析，采用 Mann-Whitney U 检验比较中位数。
21%的患者有术前阿片类药物处方，其中 24%的患者在术前有两种或两种以上的阿片类药物处方。大多数术前使用阿片类药物的患者（51%）在出院时仍使用相同的药物，但 36%的患者被换成了不同的阿片类药物，7%的患者开了另一种阿片类药物。总体而言，在剖腹手术中，术前使用阿片类药物的患者术后处方量高于未使用者。微创手术或住院时间方面，术前使用者和未使用者之间无差异。
妇科肿瘤患者术前使用阿片类药物较为常见，应在术前计划中考虑。术前使用阿片类药物与术后处方量较大和范围较广相关。超过 40%的阿片类药物使用者出院时要么开了另一种阿片类药物，要么开了一种新的阿片类药物，这突显了在不影响阿片类药物安全性的情况下优化阿片类药物安全性的潜在机会。需要进一步研究以确定术前使用阿片类药物与围手术期结局之间的关系，并制定策略在该人群中有效管理疼痛而不损害阿片类药物的安全性。
