Tondo-Steele Katelyn, Stroup Cynthia, Uppal Shitanshu, Straubhar Alli
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA.
Gynecol Oncol Rep. 2024 Jun 30;54:101446. doi: 10.1016/j.gore.2024.101446. eCollection 2024 Aug.
There remains a paucity of data for vulvar surgery outcomes in gynecologic oncology in the era of Enhanced Recovery After Surgery (ERAS) ®. As such, the primary objective is to assess the impact of patient and procedural factors on patient reported postoperative opioid usage following vulvar surgery. Secondary objective is to create a tailored opioid prescribing algorithm for this population.
A retrospective cohort study was performed of patients who underwent vulvar surgery for a gynecologic malignancy between 3/2019-7/2022. Covariates of interest included a history of risk factors for opioid usage, age, anatomic location of the vulvar resection, radicality of surgery, groin dissection, use of postoperative non-steroidal anti-inflammatory drugs (NSAIDs), and complications. Logistic regression models evaluated the effects that sociodemographic characteristics and procedural factors have on opioid usage. Linear regression models were created to determine prescribing guidelines.
A total of 100 patients were included. Following surgery, 35 patients (35 %) were not sent home with an opioid prescription, 39 patients (39 %) reported using at least one opioid pill from their prescription, and 26 patients (26 %) reported not using any opioid pills from their prescription. In the regression models, patient age (p < 0.006) had a significant impact on opioid use, while all other factors did not. Contraindications to NSAIDs did not have a statistically significant impact (p = 0.1) but was deemed clinically meaningful and included in the final model. Proposed opioid prescribing guidelines were created.
In conclusion, most patients after vulvar surgery require little to no opioids. Identifiable preoperative factors can aid providers to manage postoperative pain while minimizing unnecessary opioid prescriptions.
在手术加速康复（ERAS）®时代，妇科肿瘤外阴手术结局的数据仍然匮乏。因此，主要目的是评估患者因素和手术因素对外阴手术后患者报告的术后阿片类药物使用情况的影响。次要目的是为该人群创建一个量身定制的阿片类药物处方算法。
对2019年3月至2022年7月间因妇科恶性肿瘤接受外阴手术的患者进行了一项回顾性队列研究。感兴趣的协变量包括阿片类药物使用风险因素史、年龄、外阴切除术的解剖位置、手术根治性、腹股沟清扫、术后非甾体抗炎药（NSAIDs）的使用以及并发症。逻辑回归模型评估了社会人口学特征和手术因素对阿片类药物使用的影响。创建线性回归模型以确定处方指南。
共纳入100例患者。术后，35例患者（35%）未带阿片类药物处方出院，39例患者（39%）报告至少使用了处方中的一粒阿片类药物，26例患者（26%）报告未使用处方中的任何阿片类药物。在回归模型中，患者年龄（p < 0.006）对阿片类药物使用有显著影响，而所有其他因素则无影响。NSAIDs的禁忌症没有统计学上的显著影响（p = 0.1），但被认为具有临床意义并纳入最终模型。提出了阿片类药物处方指南。
总之，大多数外阴手术后的患者几乎不需要或不需要阿片类药物。可识别的术前因素可以帮助医护人员管理术后疼痛，同时尽量减少不必要的阿片类药物处方。
