Department of Obstetrics and Gynecology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
Unit of Gynecology and Obstetrics, Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona, University of Verona, Verona, Italy.
J Robot Surg. 2024 Apr 26;18(1):182. doi: 10.1007/s11701-024-01948-0.
To compare the in-hospital opioid and non-opioid analgesic use among women who underwent robotic-assisted hysterectomy (RH) vs. open (OH), vaginal (VH), or laparoscopic hysterectomy (LH). Records of women in the United States who underwent hysterectomy for benign gynecologic disease were extracted from the Premier Healthcare Database (2013-2019). Propensity score methods were used to create three 1:1 matched cohorts stratified in inpatients [RH vs. OH (N = 16,821 pairs), RH vs. VH (N = 6149), RH vs. LH (N = 11,250)] and outpatients [RH vs. OH (N = 3139), RH vs. VH (N = 29,954), RH vs. LH (N = 85,040)]. Opioid doses were converted to morphine milligram equivalents (MME). Within matched cohorts, opioid and non-opioid analgesic use was compared. On the day of surgery, the percentage of patients who received opioids differed only for outpatients who underwent RH vs. LH or VH (maximum difference = 1%; p < 0.001). RH was associated with lower total doses of opioids in all matched cohorts (each p < 0.001), with the largest difference observed between RH and OH: median (IQR) of 47.5 (25.0-90.0) vs. 82.5 (36.0-137.0) MME among inpatients and 39.3 (19.5-66.0) vs. 60.0 (35.0-113.3) among outpatients. After the day of surgery, fewer inpatients who underwent RH received opioids vs. OH (78.7 vs. 87.5%; p < 0.001) or LH (78.6 vs. 80.6%; p < 0.001). The median MME was lower for RH (15.0; 7.5-33.5) versus OH (22.5; 15.0-55.0; p < 0.001). Minor differences were observed for non-opioid analgesics. RH was associated with lower in-hospital opioid use than OH, whereas the same magnitude of difference was not observed for RH vs. LH or VH.
比较行机器人辅助子宫切除术（RH）与开腹（OH）、阴道（VH）或腹腔镜子宫切除术（LH）的女性住院期间阿片类药物和非阿片类药物的使用情况。从 Premier Healthcare Database（2013-2019 年）中提取了美国因良性妇科疾病接受子宫切除术的女性记录。使用倾向评分方法创建了三个 1:1 匹配队列，按住院患者分层[RH 与 OH（N=16821 对），RH 与 VH（N=6149），RH 与 LH（N=11250）]和门诊患者[RH 与 OH（N=3139），RH 与 VH（N=29954），RH 与 LH（N=85040）]。阿片类药物剂量换算为吗啡毫克当量（MME）。在匹配队列内，比较阿片类药物和非阿片类药物的使用情况。在手术当天，仅接受 RH 与 LH 或 VH 的门诊患者的接受阿片类药物的患者比例有所不同（最大差异为 1%；p<0.001）。在所有匹配队列中，RH 与较低的阿片类药物总剂量相关（均 p<0.001），其中 RH 与 OH 的差异最大：住院患者中位数（IQR）为 47.5（25.0-90.0）与 82.5（36.0-137.0）MME；门诊患者为 39.3（19.5-66.0）与 60.0（35.0-113.3）。手术日之后，接受 RH 的住院患者中接受阿片类药物的患者少于接受 OH（78.7% vs. 87.5%；p<0.001）或 LH（78.6% vs. 80.6%；p<0.001）。RH 患者的中位数 MME 低于 OH（15.0；7.5-33.5）（p<0.001）。非阿片类药物镇痛药的差异较小。RH 与较低的住院期间阿片类药物使用量相关，而 RH 与 LH 或 VH 之间没有观察到相同幅度的差异。
