Ghodoussipour Saum, Ghoreifi Alireza, Katebian Behdod, Cameron Brian H, Mitra Anirban P, Cai Jie, Miranda Gus, Schuckman Anne K, Daneshmand Siamak, Djaladat Hooman
Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, United States.
Can Urol Assoc J. 2021 Oct;15(10):E563-E568. doi: 10.5489/cuaj.7007.
The aim of this study was to evaluate the outcomes of radical cystectomy with an enhanced recovery after surgery (ERAS) protocol in patients with a history of chronic preoperative narcotic use compared to narcotic-naive patients.
We identified 553 patients who underwent open radical cystectomy with ERAS. Preoperative narcotic use was identified in 34 patients who were then matched to 68 narcotic-naive patients. Postoperative outcomes, opioid use, and visual analog scale (VAS) pain scores were analyzed and compared. All routes of opioid use were recorded and converted to a morphine equivalent dose (MED).
Patients with preoperative narcotic use reported higher median VAS pain scores per day (postoperative day [POD1]: 5.2 vs. 3.9, p=0.003; POD2: 5.1 vs. 3.6, p<0.001; POD3: 4.6 vs. 3.8, p=0.004) and used significantly more opioids (median MED) per day (POD1: 13.2 vs. 10.0, p=0.02; POD2: 11.3 vs. 6.4, p=0.003; POD3: 10.2 vs. 5.0, p=0.005) following surgery. Preoperative narcotic users were noted to have a significantly higher incidence of 90-day re-admissions (41.2% vs. 20.6%, p=0.03). There was no difference in median hospital stay (4 vs. 4 days, p=0.6), 30-or 90-day complications (64.7% vs. 60.3%, p=0.8 and 82.4% vs. 75.0%, p=0.4, respectively) or gastrointestinal complications (29.4% vs. 26.5%, p=0.8), including postoperative ileus (11.8% vs. 20.6%, p=0.2).
Patients with preoperative narcotic exposure report higher pain scores and require more opioid use following radical cystectomy with ERAS and are more likely to be re-admitted within 90 days. However, there was no observed difference in hospital stay or complications.
本研究的目的是评估与未使用过麻醉药品的患者相比，采用术后加速康复（ERAS）方案进行根治性膀胱切除术的、术前有慢性麻醉药品使用史的患者的治疗结果。
我们确定了553例行开放性根治性膀胱切除术并采用ERAS方案的患者。在34例患者中发现有术前麻醉药品使用史，然后将这些患者与68例未使用过麻醉药品的患者进行匹配。对术后结果、阿片类药物使用情况和视觉模拟评分（VAS）疼痛评分进行分析和比较。记录所有阿片类药物的使用途径并换算为吗啡等效剂量（MED）。
有术前麻醉药品使用史的患者术后每天的VAS疼痛评分中位数更高（术后第1天[POD1]：5.2对3.9，p = 0.003；POD2：5.1对3.6，p<0.001；POD3：4.6对3.8，p = 0.004），且术后每天使用的阿片类药物（MED中位数）明显更多（POD1：13.2对10.0，p = 0.02；POD2：11.3对6.4，p = 0.003；POD3：10.2对5.0，p = 0.005）。术前使用麻醉药品的患者90天再入院发生率明显更高（41.2%对20.6%，p = 0.03）。中位住院时间（4天对4天，p = 0.6）、30天或90天并发症发生率（分别为64.7%对60.3%，p = 0.8和82.4%对75.0%，p = 0.4）或胃肠道并发症发生率（29.4%对26.5%，p = 0.8），包括术后肠梗阻发生率（11.8%对20.6%，p = 0.2），均无差异。
有术前麻醉药品暴露史的患者在采用ERAS方案进行根治性膀胱切除术后报告的疼痛评分更高，需要使用更多的阿片类药物，且更有可能在90天内再次入院。然而，在住院时间或并发症方面未观察到差异。
