Homsi Joseph, Brovman Ethan Y, Rao Nikhilesh, Whang Edward E, Urman Richard D
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Center for Perioperative Research, Brigham and Women's Hospital, Boston, Massachusetts.
J Laparoendosc Adv Surg Tech A. 2019 Nov;29(11):1436-1445. doi: 10.1089/lap.2019.0408. Epub 2019 Sep 26.
Major colorectal surgery procedures are complex operations that can result in significant postoperative pain and complications. More evidence is needed to demonstrate how opioid-related adverse drug events (ORADEs) after colorectal surgery can affect hospital length of stay (LOS), hospital revenue, and what their association is with clinical conditions. By understanding the clinical and economic impact of potential ORADEs within colorectal surgery, we hope to further guide approaches to perioperative pain management in an effort to improve patient care and reduce hospital costs. We conducted a retrospective study utilizing the Centers for Medicare and Medicaid Services (CMS) Administrative Database to analyze Medicare discharges involving three colorectal surgery diagnosis-related groups (DRGs) to identify potential ORADEs. The impact of potential ORADEs on mean hospital LOS and hospital revenue was analyzed. The potential ORADE rate in patients undergoing colorectal surgery was 23.92%. The mean LOS for discharges with a potential ORADE was 5.35 days longer than without an ORADE. The mean hospital revenue per day with a potential ORADE was $418 less than without an ORADE. Any type of open surgery had a statistically significant higher potential ORADE rate than the matched laparoscopic case ( < .001). Clinical conditions most strongly associated with ORADEs in colorectal surgery included septicemia, pneumonia, shock, and fluid and electrolyte disorders. The incidence of ORADEs in colorectal surgery is high and is associated with longer hospital stays and reduced hospital revenue. Reducing the use of opioids in the perioperative setting, such as using multimodal analgesia strategies, may lead to positive outcomes with shorter hospital stays, increased hospital revenue, and improved patient care.
大肠主要手术操作是复杂的手术，可导致显著的术后疼痛和并发症。需要更多证据来证明大肠手术后与阿片类药物相关的不良药物事件（ORADEs）如何影响住院时间（LOS）、医院收入，以及它们与临床状况的关联。通过了解大肠手术中潜在ORADEs的临床和经济影响，我们希望进一步指导围手术期疼痛管理方法，以改善患者护理并降低医院成本。我们利用医疗保险和医疗补助服务中心（CMS）管理数据库进行了一项回顾性研究，以分析涉及三个大肠手术诊断相关组（DRGs）的医疗保险出院病例，以识别潜在的ORADEs。分析了潜在ORADEs对平均住院时间和医院收入的影响。接受大肠手术患者的潜在ORADEs发生率为23.92%。发生潜在ORADEs的出院患者的平均住院时间比未发生ORADEs的患者长5.35天。发生潜在ORADEs时每天的平均医院收入比未发生ORADEs时少418美元。任何类型的开放手术的潜在ORADEs发生率在统计学上显著高于匹配的腹腔镜手术病例（<0.001）。大肠手术中与ORADEs最密切相关的临床状况包括败血症、肺炎、休克以及液体和电解质紊乱。大肠手术中ORADEs的发生率很高，并且与更长的住院时间和减少的医院收入相关。在围手术期减少阿片类药物的使用，如采用多模式镇痛策略，可能会带来积极的结果，包括缩短住院时间、增加医院收入和改善患者护理。
