Professor & Director, Department of Clinical Pharmacy, Medication Outcomes Center, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco (UCSF), San Francisco, California. ORCID: https://orcid.org/0000-0002-5526-9395.
Department of Clinical Pharmacy, University of California San Francisco (UCSF), San Francisco, California.
J Opioid Manag. 2022 Jul-Aug;18(4):317-325. doi: 10.5055/jom.2022.0727.
Post-operative ileus (POI) is a common and potentially serious complication after surgery. We assessed the incidence and identified predictors of POI in older surgical patients.
A retrospective observational study.
University of California-San Francisco electronic medical record data.
Opioid-naïve, noncancer patients, aged 65 and older, who underwent elective surgery in the period 2017-2019.
Administration of opioid analgesics per day of hospitalization in opioid naïve patients.
Incidence of POI and likelihood of developing POI.
In the study period, 3 percent of opioid naïve patients developed POI. Patients with POI used on average 197.1 oral morphine equivalents (OMEs) per day of hospitalization compared to 82.5 OME in patients without POI (p = 0.013). Yet, there were not statistically significant differences in post-operative pain scores between patients with and without POI. General surgery (p = 0.0031), length of surgery (p = 0.0031), and hospital length of stay (p < 0.0001) were significant predictors of the risk for developing POI. Adjusted inpatient administration of more than 90 OME per day of hospitalization was associated with a four times greater risk for developing POI (p = 0.016). Developing POI was associated with 6.5 (95 percent confidence interval: 5.2-7.8) additional days of hospitalization among patients who developed POI compared to patients who did not develop POI (p < 0.0001).
Adjusted inpatient administration of more than 90 OME significantly increased the risk for developing POI in opioid-naïve older patients. Developing POI after surgery significantly increased the hospital length of stay. Optimizing inpatient administration of opioids may prevent opioid use-related POI and longer hospitalizations.
术后肠梗阻（POI）是手术后常见且潜在严重的并发症。我们评估了其发生率，并确定了老年手术患者发生 POI 的预测因素。
回顾性观察性研究。
加利福尼亚大学旧金山分校电子病历数据。
接受择期手术的、无阿片类药物使用史的非癌症患者，年龄在 65 岁及以上，且在 2017 年至 2019 年期间住院。
无阿片类药物使用史的患者在住院期间每天接受阿片类药物镇痛的剂量。
POI 的发生率和发生 POI 的可能性。
在研究期间，3%的无阿片类药物使用史的患者发生了 POI。发生 POI 的患者平均每天使用 197.1 口服吗啡当量（OMEs），而未发生 POI 的患者每天使用 82.5 OME（p=0.013）。然而，两组患者术后疼痛评分并无统计学差异。普通外科手术（p=0.0031）、手术时间（p=0.0031）和住院时间（p<0.0001）是发生 POI 的风险的显著预测因素。调整住院期间每天使用超过 90 OME 与发生 POI 的风险增加四倍相关（p=0.016）。与未发生 POI 的患者相比，发生 POI 的患者住院时间延长了 6.5 天（95%置信区间：5.2-7.8）（p<0.0001）。
调整住院期间每天使用超过 90 OME 显著增加了无阿片类药物使用史的老年患者发生 POI 的风险。手术后发生 POI 显著增加了住院时间。优化阿片类药物的住院管理可能会预防阿片类药物相关的 POI 和延长住院时间。
