Robinson Kortney A, Duncan Sarah, Austrie Jasmine, Fleishman Aaron, Tobias Adam, Hopwood Ruben A, Brat Gabriel
Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
J Surg Res. 2020 Jul;251:33-37. doi: 10.1016/j.jss.2019.12.043. Epub 2020 Feb 25.
There are few studies that evaluate patient-reported opioid consumption after discharge from surgery. In addition, there has been a call for "special care in prescribing opioids" for lesbian, gay, bisexual, transgender, questioning patients. Here, we evaluate if patients undergoing gender-affirming mastectomy (GAM) require different amounts of opioids for pain management after discharge compared alongside two surgeries with similar surgical exposure.
From October 2017 to July 2018, patients undergoing oncologic mastectomy without reconstruction, mammoplasty reduction, or gender-affirming mastectomy at a single institution were enrolled in a phone survey study to quantify opioids consumed after discharge from surgery. Patient information was captured from the medical record. A total of 170 patients were called between 14 and 30 d after discharge and were asked to count unused pills from their opioid prescription.
A total of 99 patients participated and provided pill counts. There were differences between prescribed and consumed opioids within each surgery. Patients who underwent oncologic mastectomy were prescribed and consumed the lowest amounts of opioids. There were significantly more opioids prescribed to patients with GAM than mammoplasty reduction, but consumption was not statistically different. Patients with oncologic mastectomy, mammoplasty reduction, and GAM consumed a median of 0, 10, and 15 five mg oxycodone equivalent tablets, respectively.
Despite similar approaches, surgeries had different opioid prescribing and use profiles. Generally, all patients were overprescribed opioids. Overprescribing may be especially problematic in patients with known higher risk of misuse and substance abuse. Granular data on patient consumption, demographics, and preoperative risk factors for opioid misuse may improve prescribing practices.
评估患者术后出院后报告的阿片类药物消耗量的研究较少。此外，有人呼吁对女同性恋、男同性恋、双性恋、跨性别、疑问患者“在开具阿片类药物时给予特别关注”。在此，我们评估接受性别确认乳房切除术（GAM）的患者在出院后与另外两种手术暴露相似的手术相比，疼痛管理所需的阿片类药物量是否不同。
2017年10月至2018年7月，在一家机构接受无重建的肿瘤乳房切除术、乳房缩小成形术或性别确认乳房切除术的患者被纳入一项电话调查研究，以量化术后出院后消耗的阿片类药物。从病历中获取患者信息。在出院后14至30天之间共致电170名患者，要求他们清点阿片类药物处方中未使用的药片。
共有99名患者参与并提供了药片计数。每种手术的阿片类药物处方量和消耗量之间存在差异。接受肿瘤乳房切除术的患者阿片类药物的处方量和消耗量最低。与乳房缩小成形术相比，接受GAM的患者阿片类药物的处方量明显更多，但消耗量无统计学差异。接受肿瘤乳房切除术、乳房缩小成形术和GAM的患者分别消耗了中位数为0、10和15片5毫克羟考酮等效片。
尽管手术方式相似，但不同手术的阿片类药物处方和使用情况不同。一般来说，所有患者的阿片类药物都开多了。在已知滥用和药物成瘾风险较高的患者中，开多药可能尤其成问题。关于患者消耗量、人口统计学和阿片类药物滥用术前风险因素的详细数据可能会改善处方做法。
