Latack Kyle R, Howard Ryan, Bicket Mark C, Cooley Samantha, Gunaseelan Vidhya, Englesbe Michael, Waljee Jennifer
From the Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.
Department of Surgery, University of Michigan, Ann Arbor, MI.
Ann Surg Open. 2024 Oct 4;5(4):e496. doi: 10.1097/AS9.0000000000000496. eCollection 2024 Dec.
To assess the relationship between postoperative opioid consumption and frailty status.
Physiologic reserve can be assessed through both chronologic age as well as measures of frailty. Although prior studies suggest that older individuals may require less opioid following surgery, chronologic age, and frailty do not always align, and little is known regarding postoperative opioid consumption patterns by frailty.
We conducted a retrospective analysis of opioid-naïve adult patients undergoing common general, vascular, and gynecologic procedures across a statewide quality improvement program from November 6, 2017 to February 28, 2021. Our primary outcome was postoperative patient-reported opioid consumption within 30 days of surgery in oral morphine equivalents (OME). Our primary exposure was frailty status defined by the modified frailty index (mFi-5) criteria. Other covariates included patient demographic and clinical attributes, procedural factors, discharge opioid prescription size, and postoperative complications. Linear regression was performed to assess the association of frailty status and opioid consumption, stratified by age.
In this cohort of 34,854 patients, 10,596 had an mFi-5 score of ≤1 and 3,635 had a score of >1. A score of >1 was associated with increased patient-reported opioid consumption (OMEs 3.3 greater; 95% CI = 1.5-5.1). This held true for individuals over 65 (OMEs 2.7 greater; 95% CI = 0.2-5.1). Frailty status, regardless of score, was negatively associated with an opioid prescription at discharge.
Frailty status is associated with increased opioid consumption after common operations. Future prescribing guidelines and outcomes analyses should consider this marker when reviewing opioid consumption data and related adverse outcomes.
评估术后阿片类药物消耗量与虚弱状态之间的关系。
生理储备可通过年龄以及虚弱程度指标进行评估。尽管先前的研究表明，老年人术后可能需要较少的阿片类药物，但年龄和虚弱程度并不总是一致的，关于虚弱状态对术后阿片类药物消费模式的影响知之甚少。
我们对2017年11月6日至2021年2月28日期间在全州范围内的质量改进项目中接受普通外科、血管外科和妇科常见手术的未使用过阿片类药物的成年患者进行了回顾性分析。我们的主要结局是患者报告的术后30天内以口服吗啡当量（OME）计算的阿片类药物消耗量。我们的主要暴露因素是根据改良虚弱指数（mFi-5）标准定义的虚弱状态。其他协变量包括患者的人口统计学和临床特征、手术因素、出院时阿片类药物处方量以及术后并发症。进行线性回归以评估虚弱状态与阿片类药物消耗量之间的关联，并按年龄分层。
在这34,854名患者的队列中，10,596名患者的mFi-5评分为≤1，3,635名患者的评分>1。评分>1与患者报告的阿片类药物消耗量增加相关（OME增加3.3；95%CI = 1.5-5.1）。65岁以上的个体也是如此（OME增加2.7；95%CI = 0.2-5.1）。无论评分如何，虚弱状态与出院时的阿片类药物处方呈负相关。
虚弱状态与常见手术后阿片类药物消耗量增加有关。未来的处方指南和结局分析在审查阿片类药物消费数据和相关不良结局时应考虑这一指标。
