Ford Jordanne, Kindel Tammy, Higgins Rana M, Lak Kathleen L, Hetzel Emily, Gould Jon C
Division of General Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
Surg Endosc. 2022 Apr;36(4):2564-2569. doi: 10.1007/s00464-021-08544-5. Epub 2021 May 12.
Evidence-based guidelines on the appropriate amount of opioid medications to prescribe following bariatric surgery are lacking. We sought to determine our current opioid-prescribing practices, patient utilization, and satisfaction with pain control following elective bariatric surgery.
A retrospective chart review and phone survey were conducted on patients who underwent laparoscopic or robotic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) from April 2018 to March 2019 at a single academic medical center. Opioid medications were converted to morphine milligram equivalents provided (MMEs).
In total, 192 patients met inclusion criteria. The median amount of opioid medication prescribed on discharge was 300 oral MMEs, although there was a significant difference between the MMEs prescribed to patients with and without chronic opioid therapy (median 300 MMEs opioid naïve vs. 375 MMEs chronic opioid therapy, p = 0.01). Significantly fewer SG patients required a refill of their opioid medication compared to RYGB (8.3% vs. 23.9%, p = 0.003). Of the 192 patients, 87 (45.3%) completed the phone survey. Fifty-six patients (64%) reported that they took half or less of the initially prescribed opioids. Of the patients with leftover medication, 36% reported that they did not dispose of the medication. Overall understanding of pain control options after surgery was significantly lower in patients who felt they were prescribed "too little" opioids (p = 0.01), patients requiring refills (p = 0.02), and patients who were not satisfied with their pain control (p = 0.02).
There is a gap between the amount of opioid medication prescribed and taken by patients following bariatric surgery in our practice. Patients who were least satisfied with their pain control reported knowledge gaps about pain control options that were more significant than patients who were more satisfied. Future initiatives should focus on the reduction of opioids prescribed to bariatric surgery patients post-operatively and on opioid education for patients.
缺乏关于减肥手术后开具阿片类药物合适剂量的循证指南。我们试图确定我们目前在择期减肥手术后的阿片类药物处方做法、患者使用情况以及对疼痛控制的满意度。
对2018年4月至2019年3月在单一学术医疗中心接受腹腔镜或机器人袖状胃切除术（SG）或Roux-en-Y胃旁路术（RYGB）的患者进行回顾性病历审查和电话调查。阿片类药物转换为提供的吗啡毫克当量（MMEs）。
共有192名患者符合纳入标准。出院时开具的阿片类药物中位数为300口服MMEs，尽管接受和未接受慢性阿片类药物治疗的患者所开具的MMEs存在显著差异（未使用阿片类药物患者的中位数为300 MMEs，慢性阿片类药物治疗患者为375 MMEs，p = 0.01）。与RYGB患者相比，SG患者需要补充阿片类药物的人数明显更少（8.3%对23.9%，p = 0.003）。在192名患者中，87名（45.3%）完成了电话调查。56名患者（64%）报告他们服用的阿片类药物为最初开具剂量的一半或更少。在有剩余药物的患者中，36%报告他们没有处理这些药物。在认为开具的阿片类药物“太少”的患者（p = 0.01）、需要补充药物的患者（p = 0.02）以及对疼痛控制不满意的患者（p = 0.02）中，对术后疼痛控制选择的总体了解明显较低。
在我们的实践中，减肥手术后患者开具和服用的阿片类药物数量之间存在差距。对疼痛控制最不满意的患者报告的关于疼痛控制选择的知识差距比更满意的患者更显著。未来的举措应侧重于减少减肥手术患者术后开具的阿片类药物数量以及对患者进行阿片类药物教育。
