Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Division of Colon and Rectal Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Division of Colon and Rectal Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
J Surg Res. 2020 Sep;253:105-114. doi: 10.1016/j.jss.2020.03.040. Epub 2020 Apr 26.
Differences in nociception and use of opioids between sexes are of particular interest, considering higher rates of persistent opioid use among women after surgery. Although enhanced recovery protocols (ERPs) have improved postoperative pain control in colorectal surgery, sex-based comparisons of inpatient opioid use after surgery in an ERP remain understudied.
This retrospective study analyzed data from adults after colorectal surgery using an ERP at a single hospital between 2015 and 2017. The main outcome was the rate of opioid consumption measured as oral morphine equivalents per inpatient day. Poisson regression determined association between sex and opioid consumption, accounting for early discharge, using inverse probability weighting and adjusting for covariates that retained significance on univariate analysis. Linear regression assessed the association between sex and pain scores on postoperative days 0-5 adjusting for covariates.
Of 588 patients included, 43% were men and 57% were women. In the unadjusted model, malignancy, prehospital psychiatric medication and analgesic use, tobacco, ileostomy creation, operative time, and postoperative complications were associated with increased opioid consumption. In multivariate analyses, prehospital opioid and nonopioid analgesic use, operative time, anastomotic leak, and postoperative ileus remained significantly associated with increased inpatient opioid consumption. However, there was no significant association between sex and opioid use in crude or adjusted analysis (incidence rate ratio: 1.09; 95% confidence interval: 0.90, 1.32). Women reported higher average daily pain scores (coefficient: 0.29; 95% confidence interval: 0.04, 0.55) in adjusted analyses.
Among patients undergoing colorectal surgery using an ERP, sex-based differences exist in pain scores but not early postoperative opioid consumption. Identification of intragroup differences in postoperative pain and opioid use among patients managed with an ERP serves as targets for customization and enhancement of current protocols. Furthermore, incongruence between reported pain and analgesic administration may have important implications for sex-related differences in persistent opioid use.
考虑到女性在手术后持续使用阿片类药物的比率较高，性别之间的痛觉和阿片类药物使用差异特别值得关注。尽管强化康复方案（ERPs）改善了结直肠手术后的疼痛控制，但 ERP 后手术后住院患者阿片类药物使用的性别比较仍研究不足。
本回顾性研究分析了 2015 年至 2017 年期间在一家医院接受 ERP 治疗的成年人结直肠手术后的数据。主要结果是每住院日口服吗啡等效物的阿片类药物消耗率。泊松回归确定了性别与阿片类药物消耗之间的关联，考虑到提前出院，使用逆概率加权，并调整了单变量分析中保留显著性的协变量。线性回归评估了术后 0-5 天性别与疼痛评分之间的关联，同时调整了协变量。
在纳入的 588 名患者中，43%为男性，57%为女性。在未调整模型中，恶性肿瘤、院前精神科药物和镇痛药使用、吸烟、回肠造口术、手术时间和术后并发症与阿片类药物消耗增加相关。在多变量分析中，院前阿片类药物和非阿片类镇痛药使用、手术时间、吻合口漏和术后肠梗阻与住院期间阿片类药物消耗增加仍显著相关。然而，在粗或调整分析中，性别与阿片类药物使用之间无显著关联（发病率比：1.09；95%置信区间：0.90，1.32）。在调整分析中，女性报告的平均每日疼痛评分较高（系数：0.29；95%置信区间：0.04，0.55）。
在接受 ERP 治疗的结直肠手术患者中，疼痛评分存在性别差异，但术后早期阿片类药物消耗无性别差异。在接受 ERP 治疗的患者中，确定术后疼痛和阿片类药物使用的组内差异是定制和增强当前方案的目标。此外，报告的疼痛与镇痛药物管理之间的不匹配可能对女性持续使用阿片类药物的差异具有重要意义。
