经口机器人手术治疗口咽癌后阿片类药物使用和处方预测因素。
Opioid Usage and Prescribing Predictors Following Transoral Robotic Surgery for Oropharyngeal Cancer.
机构信息
Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A.
出版信息
Laryngoscope. 2021 Jun;131(6):E1888-E1894. doi: 10.1002/lary.29276. Epub 2020 Nov 19.
OBJECTIVE/HYPOTHESIS: Pain management following transoral robotic surgery (TORS) varies widely. We aim to quantify opioid usage following TORS for oropharyngeal squamous cell carcinoma (OPSCC) and identify prescribing predictors.
STUDY DESIGN
Retrospective cohort study.
METHODS
A consecutive series of 138 patients undergoing TORS for OPSCC were reviewed from 2016 to 2019. Opioid usage (standardized to morphine milligram equivalents [MME]) was gathered for 12 months post-surgery via prescribing record cross-check with the Massachusetts Prescription Awareness Tool.
RESULTS
Of 138 OPSCC TORS patients, 92.8% were human papillomavirus (HPV) positive. Adjuvant therapy included radiation (XRT;67.4%) and chemoradiation (cXRT;6.5%). Total MME usage from start of treatment averaged 1395.7 MMEs with 76.4% receiving three prescriptions or less. Categorical analysis showed age <65, male sex, overweight BMI, lower frailty, former smokers, HPV+, higher T stage, and BOT subsite to be associated with increased MMEs. Adjuvant therapy significantly increased MMEs (TORS+XRT:1646.2; TORS+cXRT:2385.0; TORS alone:554.7 [P < .001]) and 12-month opioid prescription totals (TORS+XRT:3.2; TORS+cXRT:5.5; TORS alone:1.6 [P < .001]). Adjuvant therapy increased time to taper (total MME in TORS alone versus TORS+XRT/cXRT: 0 to 3 months:428.2 versus 845.5, 4 to 6 months:46.8 versus 541.8, 7 to 9 months:12.4 versus 178.6, 10 to 12 months:11.0 versus 4.4,[P < .001]). Positive predictors of opioid prescribing at the 4- to 6-month and 4- to 12-month intervals included adjuvant therapy (odds ratio [OR]:5.56 and 4.51) and mFI-5 score ≥3 (OR:36.67 and 31.94). Following TORS at 6-, 9-, and 12-month, 15.7%, 6.6%, and 4.1% were still using opioids.
CONCLUSIONS
In OPSCC treated with TORS, opioid use tapers faster for surgery alone versus with adjuvant therapy. Opioid prescribing risks include adjuvant therapy and higher frailty index.
LEVEL OF EVIDENCE
4 Laryngoscope, 131:E1888-E1894, 2021.
目的/假设：经口机器人手术（TORS）后的疼痛管理差异很大。我们旨在量化 TORS 治疗口咽鳞状细胞癌（OPSCC）后的阿片类药物使用情况，并确定处方预测因素。
研究设计
回顾性队列研究。
方法
对 2016 年至 2019 年间接受 TORS 治疗的 138 例 OPSCC 患者进行了连续系列研究。通过与马萨诸塞州处方意识工具交叉核对处方记录，在手术后 12 个月内收集阿片类药物使用情况（标准化为吗啡毫克当量[MME]）。
结果
在 138 例 OPSCC TORS 患者中，92.8%为人乳头瘤病毒（HPV）阳性。辅助治疗包括放疗（XRT；67.4%）和放化疗（cXRT；6.5%）。从治疗开始时的总 MME 使用量平均为 1395.7 MME，76.4%的患者接受了三剂或更少的药物。分类分析显示年龄<65 岁、男性、超重 BMI、较低的脆弱性、曾经吸烟、HPV+、较高的 T 分期和 BOT 亚部位与 MME 增加相关。辅助治疗显著增加了 MME（TORS+XRT：1646.2；TORS+cXRT：2385.0；TORS 单独：554.7[P<.001]）和 12 个月阿片类药物处方总数（TORS+XRT：3.2；TORS+cXRT：5.5；TORS 单独：1.6[P<.001]）。辅助治疗增加了减药时间（TORS 单独与 TORS+XRT/cXRT 之间的总 MME：0 至 3 个月：428.2 与 845.5，4 至 6 个月：46.8 与 541.8，7 至 9 个月：12.4 与 178.6，10 至 12 个月：11.0 与 4.4[P<.001]）。4-6 个月和 4-12 个月阿片类药物处方的阳性预测因素包括辅助治疗（比值比[OR]：5.56 和 4.51）和 mFI-5 评分≥3（OR：36.67 和 31.94）。在 TORS 治疗后 6、9 和 12 个月时，仍有 15.7%、6.6%和 4.1%的患者在使用阿片类药物。
结论
在接受 TORS 治疗的 OPSCC 患者中，单独手术治疗的阿片类药物使用比辅助治疗更快减少。阿片类药物处方的风险因素包括辅助治疗和较高的脆弱指数。
证据水平
4 Laryngoscope，131：E1888-E1894，2021.
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