Dhar Sarit, Kothari Dhruv S, Reeves Camille, Sheyn Anthony M, Gillespie Marion Boyd, Rangarajan Sanjeet V
Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
Department of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Ann Otol Rhinol Laryngol. 2025 Feb;134(2):79-86. doi: 10.1177/00034894241295471. Epub 2024 Oct 29.
Despite growing concern regarding over-prescription of narcotic pain medication following ambulatory surgery, little is known about the analgesic prescribing practices following endoscopic sinus surgery (ESS) in obese patients in comparison to non-obese patients.
To compare the rates of opioid versus non-opioid prescriptions, the need for steroids, and post-operative adverse events between obese and non-obese adult patients undergoing ESS.
Using TriNetX Live database, we identified all patients aged ≥18 years who underwent ESS (n = 1303) between 2014 and 2022 across several healthcare institutions across the state of Tennessee. We 1:1 propensity score-matched obese (BMI ≥ 30 kg/m) and non-obese (18.5 kg/m ≤ BMI < 30 kg/m) cohorts for age, gender, race, and comorbidities including asthma, nicotine dependence, and sleep apnea. Rates of prescriptions and post-operative adverse events between cohorts were analyzed using risk ratios (RR) and confidence intervals (CI).
A toal of 532 obese patients were compared to 532 propensity score-matched non-obese patients in the first 14 post-operative days following ESS. The obese cohort was significantly more likely to be prescribed analgesics generally (RR = 1.72; 95% CI = 1.20-2.47), non-opioid analgesics (RR = 1.73; 95% CI = 1.19-2.50), and opioid analgesics (RR = 1.64; 95% CI = 1.14-2.36) than non-obese patients. There was no difference in rates of antibiotic or antiemetic prescription, prednisone/methylprednisolone, dexamethasone, ED visits, critical care service, epistaxis, transfusion, anemia, revision sinus surgery, mechanical ventilation, CPAP, or inhalation airway treatments.
Obese patients undergoing ESS were significantly more likely to be prescribed non-opioid and opioid analgesia in the first 14 days post-operatively compared to non-obese patients. There were no differences in post-operative adverse events or other prescriptions. Otolaryngologists should be aware that obese patients are at increased risk of opioid induced airway obstruction and steroid induced hyperglycemia, especially in patients with comorbid sleep apnea or diabetes. Emphasis on non-opioid analgesics and multimodal pain management should be advocated for this population.
尽管人们越来越关注门诊手术后麻醉性止痛药物的过度处方问题，但与非肥胖患者相比，对于肥胖患者在内镜鼻窦手术（ESS）后的止痛处方实践知之甚少。
比较接受ESS的肥胖和非肥胖成年患者中阿片类药物与非阿片类药物的处方率、类固醇的使用需求以及术后不良事件。
使用TriNetX实时数据库，我们确定了2014年至2022年间在田纳西州多家医疗机构接受ESS的所有年龄≥18岁的患者（n = 1303）。我们按1:1倾向评分匹配肥胖（BMI≥30 kg/m²）和非肥胖（18.5 kg/m²≤BMI＜30 kg/m²）队列的年龄、性别、种族和合并症，包括哮喘、尼古丁依赖和睡眠呼吸暂停。使用风险比（RR）和置信区间（CI）分析队列之间的处方率和术后不良事件。
在ESS后的前14天，共将532名肥胖患者与532名倾向评分匹配的非肥胖患者进行了比较。肥胖队列比非肥胖患者更有可能被普遍开具镇痛药（RR = 1.72；95%CI = 1.20 - 2.47）、非阿片类镇痛药（RR = 1.73；95%CI = 1.19 - 2.50）和阿片类镇痛药（RR = 1.64；95%CI = 1.14 - 2.36）。抗生素或止吐药处方率、泼尼松/甲基泼尼松龙、地塞米松、急诊就诊、重症监护服务、鼻出血、输血、贫血、鼻窦手术翻修、机械通气、持续气道正压通气（CPAP）或吸入气道治疗方面没有差异。
与非肥胖患者相比，接受ESS的肥胖患者在术后14天内更有可能被开具非阿片类和阿片类镇痛药。术后不良事件或其他处方方面没有差异。耳鼻喉科医生应意识到肥胖患者发生阿片类药物引起的气道阻塞和类固醇引起的高血糖的风险增加，尤其是在合并睡眠呼吸暂停或糖尿病的患者中。对于该人群，应提倡强调非阿片类镇痛药和多模式疼痛管理。
