Department of Otolaryngology-Head and Neck Surgery at Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA.
Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
Otolaryngol Head Neck Surg. 2021 Oct;165(4):550-555. doi: 10.1177/0194599821992365. Epub 2021 Mar 2.
Postoperative prescription narcotics increase access to opioids and associated abuse among patients, family, and acquaintances. Judicious opioid stewardship is required. Best practice questions remain for larger head and neck surgeries. We aim to review opioid utilization patterns in an urban patient population to identify patients at risk for poor postoperative pain control.
Case series with planned chart review for patients undergoing head and neck surgery (2015-2018).
Single urban hospital.
Outcome measures included postoperative phone calls and emergency room visits as markers for inadequate pain control. Age, sex, race, body mass index (BMI), smoking status, comorbidities, prior narcotic filling behavior, surgery type, and duration were evaluated as potential risk factors for pain control. Chi-square and Wilcoxon tests were used for group comparisons.
In total, 215 patients met inclusion criteria: male (22%), white/Hispanic (47%), and African American (44%). Median BMI was 31.6 kg/m; median age was 52 years. Surgeries included total thyroidectomy (41%), hemithyroidectomy (27%), and parathyroidectomy (15%). The 23-hour observation patients (n = 175, 81%) had a median of 20 morphine milligram equivalents (MMEs). Sixteen patients experienced inadequate pain control. Female sex ( = .03), younger age ( = .02), current smoker ( = .03), and higher inpatient MME ( = .006) were associated with inadequate pain control.
Female sex, younger age, smokers, and high inpatient opioid dose requirements are associated with inadequately controlled pain. These patients may benefit from additional education, earlier postoperative visits, and a more comprehensive nonopioid regimen.
术后处方类阿片药物的使用增加了患者、家属和熟人获取阿片类药物的机会，同时也增加了相关滥用的风险。因此需要谨慎管理阿片类药物。对于大型头颈部手术，最佳实践问题仍然存在。我们旨在回顾城市患者人群中阿片类药物的使用模式，以确定术后疼痛控制不佳的风险患者。
回顾性病例系列研究，对 2015 年至 2018 年间接受头颈部手术的患者进行病历回顾。
单家城市医院。
术后电话随访和急诊就诊作为评估疼痛控制不足的指标。评估年龄、性别、种族、体重指数（BMI）、吸烟状况、合并症、既往阿片类药物使用情况、手术类型和持续时间等潜在危险因素与疼痛控制的相关性。采用卡方检验和 Wilcoxon 检验进行组间比较。
共有 215 例患者符合纳入标准：男性（22%），白人/西班牙裔（47%）和非裔美国人（44%）。BMI 中位数为 31.6kg/m；中位年龄为 52 岁。手术类型包括甲状腺全切除术（41%）、甲状腺叶切除术（27%）和甲状旁腺切除术（15%）。23 小时观察患者（n=175，81%）的吗啡毫克当量（MME）中位数为 20mg。16 例患者疼痛控制不佳。女性（ =.03）、年龄较小（ =.02）、当前吸烟者（ =.03）和较高的住院 MME（ =.006）与疼痛控制不佳相关。
女性、年龄较小、吸烟者和较高的住院阿片类药物剂量需求与疼痛控制不佳相关。这些患者可能受益于额外的教育、更早的术后访视和更全面的非阿片类药物治疗方案。
