Sawczyn Guilherme, Lenfant Louis, Aminsharifi Alireza, Kim Soodong, Kaouk Jihad
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Unit of Predictive Onco-urology, Department of Urology, GRC N. 5, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.
Minerva Urol Nephrol. 2021 Oct;73(5):591-599. doi: 10.23736/S2724-6051.20.04038-2. Epub 2020 Dec 1.
The aim of this study was to evaluate perioperative factors associated with opioid-free management after robotic radical prostatectomy in a single institution.
From January 2019 to January 2020, data from patients who underwent robotic radical prostatectomy was retrospectively entered in a preapproved IRB database. Data were analyzed according to the postoperative opioid administration in hospital and/or after discharge. Robotic radical prostatectomy was performed using either the standard multi-port Da Vinci Si robotic platform with a transperitoneal approach (MP-RALP) or the novel DaVinci SP robotic platform (Intuitive Surgical, Inc., Sunnyvale, CA, USA) with an extraperitoneal approach (SP-EPP). Patients undergoing minimally invasive surgery were included in the "enhanced recovery after surgery" (ERAS) protocol regardless of the surgery approach.
During the study period, 210 patients matched the selection criteria. Of those, 158(75%) patients received opioids during the hospital stay or after discharge and 52(25%) patients never received opioids. SP-EPP surgical approach and shorter LOS were predictors of never receiving opioids (Odds Ratio [OR]=4.97, (95% CI 1.81-14.77, P=0.002 and OR=0.56, CI 95% 0.35-0.86, P=0.011, respectively). SP-EPP surgical approach was increasing the odds of remaining opioid free whether in-hospital or after discharge (OR= 11.97, 95% CI 4.8-32, P<0.0001 and OR=11.6, 95% CI 4.6-31, P<0.0001, respectively). Finally, a high BMI increased the odds of receiving opioid in hospital or after discharge (OR=0.89, 95% CI 0.82-0.96, P=0.003 and OR=0.89, 95% CI 0.82-0.96, P=0.002, respectively).
In this series, after robotic radical prostatectomy the use of a less invasive approach (SP-EPP), a shorter LOS and a lower BMI, were predictive of opioid-free status.
本研究的目的是评估单一机构中机器人根治性前列腺切除术后与无阿片类药物管理相关的围手术期因素。
2019年1月至2020年1月，将接受机器人根治性前列腺切除术患者的数据回顾性录入预先批准的机构审查委员会（IRB）数据库。根据患者术后在医院和/或出院后使用阿片类药物的情况进行数据分析。机器人根治性前列腺切除术采用标准的多端口达芬奇Si机器人平台经腹途径（MP-RALP）或新型达芬奇SP机器人平台（美国加利福尼亚州森尼韦尔市直观外科公司）经腹膜外途径（SP-EPP）进行。无论手术方式如何，接受微创手术的患者均纳入“术后加速康复”（ERAS）方案。
在研究期间，210例患者符合入选标准。其中，158例（75%）患者在住院期间或出院后使用了阿片类药物，52例（25%）患者从未使用过阿片类药物。SP-EPP手术方式和较短的住院时间是未使用阿片类药物的预测因素（优势比[OR]=4.97，95%可信区间[CI]1.81-14.77，P=0.002；OR=0.56，95%CI 0.35-0.86，P=0.011）。无论在住院期间还是出院后，SP-EPP手术方式均增加了未使用阿片类药物的几率（OR分别为11.97，95%CI 4.8-32，P<0.0001；OR=11.6，95%CI 4.6-31，P<0.0001）。最后，高体重指数增加了住院期间或出院后使用阿片类药物的几率（OR分别为=0.89，95%CI 0.82-0.96，P=0.003；OR=0.89，95%CI 0.82-0.96，P=0.002）。
在本系列研究中，机器人根治性前列腺切除术后，采用侵入性较小的手术方式（SP-EPP）、较短的住院时间和较低的体重指数可预测无阿片类药物状态。
