Tan Wen Hui, Ford Jordanne, Kindel Tammy, Higgins Rana M, Lak Kathleen, Gould Jon C
Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd. HUB, 6th Floor, Milwaukee, WI, 53226, USA.
Surg Endosc. 2023 Apr;37(4):3103-3112. doi: 10.1007/s00464-022-09482-6. Epub 2022 Aug 4.
Routine opioid use in surgical patients has received attention given the opioid epidemic and a renewed focus on the dangers and drawbacks of opioids in the postoperative setting. Little is known about opioid use in bariatric surgery, especially in the inpatient setting. We hypothesize that a standardized opioid-sparing protocol reduces postoperative inpatient opioid use in bariatric surgery patients.
A retrospective cohort study was conducted of bariatric surgery patients at a single institution. From March to September 2019, a standardized intraoperative and postoperative opioid-sparing protocol was designed and implemented along with an educational program for patients regarding safe pain management. Inpatient opioid utilization in patients undergoing surgery in the preintervention phase between April and March 2019 was compared to patients from a postintervention phase of October 2019 to December 2020. Opioid utilization was measured in morphine milliequivalents (MME).
A total of 359 patients were included; 192 preintervention and 167 postintervention. Patients were similar demographically. For all patients, mean age was 44.1 years, mean BMI 49.2 kg/m2, and 80% were female. Laparoscopic sleeve gastrectomy was performed in 48%, laparoscopic gastric bypass in 34%, robotic sleeve gastrectomy in 17%, and robotic gastric bypass in 1%. In the postintervention phase inpatient opioid utilization was significantly lower [median 134.8 [79.0-240.8] MME preintervention vs. 61.5 [35.5-150.0] MME postintervention (p < 0.001)]. MME prescribed at discharge decreased from a median of 300 MME preintervention to 75 MME postintervention (p < 0.001). In the postintervention phase, 16% of patients did not receive an opioid prescription at discharge compared to 0% preintervention (p < 0.001). When examining by procedure, statistically significant reductions in opioid utilization were seen for each operation.
Implementation of a standardized intraoperative and postoperative multimodal pain regimen and educational program significantly reduces inpatient opioid utilization in patients undergoing bariatric surgery.
鉴于阿片类药物流行以及对术后阿片类药物危害和缺点的重新关注，手术患者常规使用阿片类药物受到了关注。关于肥胖症手术中阿片类药物的使用，尤其是在住院环境中的使用情况，人们知之甚少。我们假设标准化的阿片类药物节省方案可减少肥胖症手术患者术后住院期间的阿片类药物使用。
对一家机构的肥胖症手术患者进行了一项回顾性队列研究。2019年3月至9月，设计并实施了标准化的术中和术后阿片类药物节省方案以及针对患者的安全疼痛管理教育计划。将2019年4月至3月干预前阶段接受手术患者的住院阿片类药物使用情况与2019年10月至2020年12月干预后阶段的患者进行比较。阿片类药物使用量以吗啡毫克当量（MME）衡量。
共纳入359例患者；192例干预前患者和167例干预后患者。患者在人口统计学上相似。所有患者的平均年龄为44.1岁，平均体重指数为49.2kg/m²，80%为女性。48%的患者接受了腹腔镜袖状胃切除术，34%接受了腹腔镜胃旁路术，17%接受了机器人袖状胃切除术，1%接受了机器人胃旁路术。在干预后阶段，住院阿片类药物使用量显著降低[干预前中位数为134.8[79.0 - 240.8] MME，干预后为61.5[35.5 - 150.0] MME（p < 0.001）]。出院时开具的MME从干预前的中位数300 MME降至干预后的75 MME（p < 0.001）。在干预后阶段，16%的患者出院时未接受阿片类药物处方，而干预前为0%（p < 0.001）。按手术方式检查时，每种手术的阿片类药物使用量均有统计学显著降低。
实施标准化的术中和术后多模式疼痛治疗方案及教育计划可显著降低肥胖症手术患者的住院阿片类药物使用量。
