Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Health and Society, University of Toronto Scarborough, Scarborough, Ontario, Canada.
Acta Obstet Gynecol Scand. 2023 Oct;102(10):1371-1377. doi: 10.1111/aogs.14638. Epub 2023 Aug 16.
Our objective was to explore the relation between patient age and postoperative opioid use up to 24 hours following pelvic organ prolapse (POP) surgery.
We conducted a prospective cohort study following 335 women ranging in age from 26 to 82 years who underwent surgery for multi-compartment POP at a tertiary center in Alberta, Canada. Patient characteristics were measured using baseline questionnaires. Perioperative data were collected from medical chart review during and up to 24 hours following surgery. We used logistic regression to analyze the odds of being opioid-free and linear regression to analyze mean differences in opioid dose, measured as total morphine equivalent daily dose, exploring for a potential non-linear effect of age. Adjusted models controlled for preoperative pain, surgical characteristics and patient health factors.
Overall, age was positively associated with greater odds of being opioid-free in the first 24 hours after surgery (adjusted odds ratio per increasing year of age = 1.07, 95% confidence interval [CI] 1.04-1.09, n = 332 women). Among opioid users, age was inversely associated with total opioid dose (adjusted mean difference per increasing year of age = 0.71 mg morphine equivalent daily dose, 95% CI -0.99 to -0.44, n = 204 women). There was no evidence of a non-linear relation between age and postoperative opioid use or dose.
In the context of POP surgery, we found that younger women were more likely to use opioids after surgery and to use a higher dose in the first 24 hours when compared with older women. These findings support physicians to consider age when counseling POP patients regarding pain management after surgery, and to direct resources aimed at opioid-free pain control towards younger patients.
我们的目的是探讨盆腔器官脱垂（POP）手术后 24 小时内患者年龄与术后阿片类药物使用之间的关系。
我们在加拿大艾伯塔省的一家三级中心对年龄在 26 至 82 岁之间接受多部位 POP 手术的 335 名女性进行了前瞻性队列研究。使用基线问卷测量患者特征。从手术期间和手术后 24 小时内的病历回顾中收集围手术期数据。我们使用逻辑回归分析无阿片类药物的可能性，使用线性回归分析阿片类药物剂量的平均值差异，以总吗啡等效日剂量衡量，探索年龄的潜在非线性效应。调整模型控制了术前疼痛、手术特征和患者健康因素。
总体而言，年龄与术后 24 小时内无阿片类药物的可能性呈正相关（调整后每增加 1 岁的优势比为 1.07，95%置信区间 [CI] 为 1.04-1.09，n=332 名女性）。在使用阿片类药物的患者中，年龄与总阿片类药物剂量呈负相关（调整后每增加 1 岁的平均差异为 0.71mg 吗啡等效日剂量，95%CI -0.99 至 -0.44，n=204 名女性）。年龄与术后阿片类药物使用或剂量之间没有非线性关系的证据。
在 POP 手术的背景下，我们发现与老年女性相比，年轻女性术后更有可能使用阿片类药物，并且在术后 24 小时内使用更高剂量的阿片类药物。这些发现支持医生在向 POP 患者提供手术后疼痛管理咨询时考虑年龄，并将资源用于指导年轻患者实现无阿片类药物的疼痛控制。
