Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A.
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.
Retrospective cohort study.
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.
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.
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.
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。
回顾性队列研究。
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]）。
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。
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。
4 Laryngoscope，131：E1888-E1894，2021.
