Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
HPB (Oxford). 2021 Feb;23(2):212-219. doi: 10.1016/j.hpb.2020.05.011. Epub 2020 Jun 16.
Inpatient opioid utilization following major surgery remains relatively unknown. We sought to characterize inpatient opioid consumption following hepatopancreatic surgery and determine factors associated with the variability in opioid utilization.
Adult patients who underwent hepatopancreatic surgery at a single institution were identified. Multimodal pain management strategies assessed included opioids (oral morphine equivalents, OME), acetaminophen, ibuprofen and ketorolac.
Among 2,054 patients, the median total OME utilized was 465 (129-815) during a patient's hospitalization following hepatopancreatic surgery. The interquartile range for total OMEs administered following hepatopancreatic surgery was as high as 940 OMEs (125 oxycodone-5mg pills) following a pancreaticoduodenectomy versus 520 OMEs (69 oxycodone-5mg pills) following a hemi-hepatectomy. Despite relatively high use of acetaminophen post-operatively (n = 1,588, 77.0%), multimodal pain control with acetaminophen and ibuprofen was infrequent (n = 175, 8.5%). Furthermore, individuals with high opioid utilization used on average 147 OMEs (20 oxycodone-5mg pills) the day before discharge versus 44 OME (6 oxycodone-5mg pills) among patients with expected opioid utilization.
Marked variability in inpatient opioid consumption following hepatopancreatic surgery was noted. Future work is necessary to decrease the variability in inpatient opioid prescribing practices to promote the safe and effective management of pain.
肝胰手术后患者的住院阿片类药物使用情况仍相对未知。我们旨在描述肝胰手术后患者的住院阿片类药物消耗情况，并确定与阿片类药物使用变异性相关的因素。
在一个机构中确定了接受肝胰手术的成年患者。评估了多种模式的疼痛管理策略，包括阿片类药物（口服吗啡等效物，OME）、对乙酰氨基酚、布洛芬和酮咯酸。
在 2054 名患者中，肝胰手术后患者住院期间的中位数 OME 总用量为 465（129-815）。接受胰十二指肠切除术患者的 OME 总用量范围高达 940 OME（125 片羟考酮 5mg 片），而接受半肝切除术患者的 OME 总用量为 520 OME（69 片羟考酮 5mg 片）。尽管术后患者普遍使用了较高剂量的对乙酰氨基酚（n=1588，77.0%），但对乙酰氨基酚和布洛芬的多模式止痛控制很少见（n=175，8.5%）。此外，高阿片类药物用量患者在出院前平均每天使用 147 OME（20 片羟考酮 5mg 片），而预计阿片类药物用量患者每天使用 44 OME（6 片羟考酮 5mg 片）。
肝胰手术后患者的住院阿片类药物使用量存在明显差异。未来需要进一步努力，减少住院阿片类药物处方的变异性，以促进安全有效的疼痛管理。
