Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
J Surg Res. 2020 Mar;247:264-270. doi: 10.1016/j.jss.2019.10.014. Epub 2019 Nov 6.
Both enhanced recovery and anesthesia literature recommend multimodal perioperative analgesia to hasten recovery, prevent adverse events, and reduce opioid use after surgery. However, adherence to, and outcomes of, these recommendations are unknown. We sought to characterize use of multimodal analgesia and its association with length of stay after colectomy.
Within a statewide, 72-hospital collaborative quality initiative, we evaluated postoperative analgesia regimens among adult patients undergoing elective colectomy between 2012 and 2015. We used logistic regression to identify factors associated with the use of multimodal analgesia and performed multivariable linear regression to evaluate its association with postoperative length of stay (LOS).
Among 7265 patients who underwent elective colectomy in the study period, 4660 (64.1%) received multimodal analgesia, 2405 (33.1%) received opioids alone, and 200 (2.8%) received one nonopioid pain medication alone. Multimodal analgesia was independently associated with shorter adjusted postoperative LOS, compared with opioids alone (5.60 d [95% CI 5.38-5.81] versus 5.96 d [5.68-6.24], P = 0.016).
Multimodal analgesia is associated with shorter LOS, yet one-third of patients statewide received opioids alone after colectomy. As surgeons increasingly focus on our role in the opioid crisis, particularly in postdischarge opioid prescribing, we must also focus on inpatient postoperative pain management to limit opioid exposure. At the hospital level, this may have the added benefit of decreasing LOS and hastening recovery.
强化康复和麻醉文献均建议采用多模式围手术期镇痛以加速康复，预防不良事件，并减少手术后阿片类药物的使用。然而，这些建议的遵循情况和结果尚不清楚。我们旨在描述多模式镇痛的使用情况，并探讨其与结肠切除术患者住院时间的关系。
在一项全州范围内的 72 家医院合作质量倡议中，我们评估了 2012 年至 2015 年间接受择期结肠切除术的成年患者的术后镇痛方案。我们使用逻辑回归来确定与多模式镇痛使用相关的因素，并进行多变量线性回归来评估其与术后住院时间（LOS）的关系。
在研究期间接受择期结肠切除术的 7265 例患者中，4660 例（64.1%）接受了多模式镇痛，2405 例（33.1%）仅接受阿片类药物镇痛，200 例（2.8%）仅接受一种非阿片类药物镇痛。与仅接受阿片类药物相比，多模式镇痛与调整后的术后 LOS 更短相关（5.60 天[95%CI 5.38-5.81] 与 5.96 天[5.68-6.24]，P=0.016）。
多模式镇痛与 LOS 更短相关，但全州仍有三分之一的患者在结肠切除术后仅接受阿片类药物治疗。随着外科医生越来越关注我们在阿片类药物危机中的作用，特别是在出院后阿片类药物的处方方面，我们还必须关注住院期间的术后疼痛管理，以限制阿片类药物的暴露。在医院层面，这可能会带来缩短 LOS 和加速康复的额外好处。
