Ehlers Mark E, Mohan Charan S, Akerman Jason P, McGowan Micah, McCormick Benjamin J, Hacker Kathryn E, Coward R Matthew, Figler Bradley D
Department of Urology, University of North Carolina, Chapel Hill, NC, USA.
The Smith Institute for Urology, New Hyde Park, NY, USA.
J Sex Med. 2021 Nov;18(11):1915-1920. doi: 10.1016/j.jsxm.2021.08.009. Epub 2021 Oct 13.
While there is an increasing burden of chronic postoperative opioid use and opioid abuse in the United States, opioid use following inflatable penile prosthesis (IPP) surgery has not been well described.
Describe postoperative opioid use following IPP surgery.
Seventy-four consecutive patients undergoing IPP implantation by a single surgeon were enrolled. Self-reported diaries tracked the type and amount of medication taken for 2 weeks following IPP surgery. High opioid consumers were defined as those consuming more than the median amount (10 mg) of opioids during the first 2 weeks postoperatively. Multivariate analyses were performed using stepwise backward elimination.
Quantification of opioid use postoperatively and factors related to high opioid use.
Fifty-six patients were included after 7 were excluded for preoperative opioid use and 11 were excluded for inability to contact. Median age was 67.5. Devices used were Boston Scientific (41, 73%) and Coloplast (15, 27%). All patients received local anesthetic. Most surgeries (44, 79%) were performed as outpatient. Preoperative analgesia with acetaminophen, celecoxib, and pregabalin was administered in 44 (78%), 44 (78%), and 28 (50%) of cases respectively; 32 (57%) of patients received 2 medications, 21 (36%) received three medications. In hospital median morphine equivalents was 7.5 (interquartile range [IQR] 0-7.5). Oxycodone prescribed at discharge was 50 mg (29, 52%), 75 mg (4; 7%), and 100 mg (23; 41%). Median milligrams of oxycodone used was 10 mg (IQR 0-23.5) at 7 days and 10 (IQR 0-37.5) at 14 days postdischarge. On univariate analysis, factors associated with an increased likelihood of high opioid use were morphine equivalents utilized in hospital (odds ratio [OR] 1.13, P < .05) and milligrams oxycodone prescribed at discharge (OR 1.05, P < .001) while patient demographics, procedure characteristics, and analgesic types were not found to be predictive of high opioid use. On multivariate analysis, milligrams oxycodone prescribed at discharge (OR 1.04, P < .005) were associated with an increased likelihood of high opioid use after discharge.
Increased understanding of opioid use after IPP surgery may improve prescribing patterns after discharge.
STRENGTHS & LIMITATIONS: This study quantified post discharge opioid use over the first 14 postoperative days. It is limited by single surgeon, small sample size, and retrospective design.
Provider opioid prescribing patterns were associated with high opioid consumption postoperatively and a substantial amount of opioids prescribed at discharge remain unused by patients, suggesting that we can reduce or replace the amount of opioids that are prescribed. Ehlers ME, Mohan CS, Akerman JP, et al. Factors Impacting Postoperative Opioid Use Among Patients Undergoing Implantation of Inflatable Penile Prosthesis. J Sex Med 2021;18:1915-1920.
在美国，慢性术后阿片类药物使用和阿片类药物滥用的负担日益加重，但阴茎假体植入术（IPP）后阿片类药物的使用情况尚未得到充分描述。
描述IPP手术后的阿片类药物使用情况。
纳入由单一外科医生连续进行IPP植入手术的74例患者。通过患者自我报告的日记记录IPP手术后2周内服用药物的类型和数量。高阿片类药物消费者定义为术后前2周内阿片类药物消耗量超过中位数（10毫克）的患者。采用逐步向后排除法进行多因素分析。
术后阿片类药物使用情况的量化以及与高阿片类药物使用相关的因素。
排除7例术前使用阿片类药物的患者和11例无法联系到的患者后，纳入56例患者。中位年龄为67.5岁。使用的器械为波士顿科学公司（41例，73%）和康乐保公司（15例，27%）的产品。所有患者均接受局部麻醉。大多数手术（44例，79%）为门诊手术。分别有44例（78%）、44例（78%）和28例（50%）的患者术前使用对乙酰氨基酚、塞来昔布和普瑞巴林进行镇痛；32例（57%）患者使用两种药物，21例（36%）患者使用三种药物。住院期间吗啡当量中位数为7.5（四分位间距[IQR] 0 - 7.5）。出院时开具的羟考酮剂量为50毫克（29例，52%）、75毫克（4例，7%）和100毫克（23例，41%）。出院后7天时羟考酮使用毫克数中位数为10毫克（IQR 0 - 23.5），14天时为10毫克（IQR 0 - 37.5）。单因素分析显示，与高阿片类药物使用可能性增加相关的因素为住院期间使用的吗啡当量（比值比[OR] 1.1
