Woo Kimberly P, Zheng Xinyan, Goel Amitabh P, Higgins Rana M, Iacco Anthony A, Harris Todd S, Warren Jeremy A, Reinhorn Michael, Petro Clayton C
Department of Surgery, Cleveland Clinic, Cleveland, OH, USA.
Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
Hernia. 2024 Dec 26;29(1):54. doi: 10.1007/s10029-024-03247-x.
Despite efforts to minimize opioid prescribing, outpatient ventral hernia repair (VHR) with mesh remains notoriously painful, often requiring postoperative opioid analgesia. Here, we aim to characterize patterns of opioid prescribing for the heterogenous group of patients and procedures that comprise mesh-based, outpatient VHR.
The Abdominal Core Health Quality Collaborative registry was queried for patients undergoing VHR with mesh who were discharged the same or next day between January 2019 to October 2023. Procedures were broadly classified by approach and mesh location: open, minimally-invasive with intraperitoneal mesh (MIP), and minimally-invasive with retromuscular or preperitoneal mesh (MRPP). Surgeon-reported opioid prescription quantity and patient-reported 30-day consumption data were reviewed.
Of 2,795 patients who met inclusion criteria (46.1% open, 22.7% MIP, 31.2% MRPP), approximately 80% of patients consumed ≤ 10 tablets of opioid pain medication (open 87.7%, MIP 78.4%, MRPP 84.2%). For patients who were prescribed ≤ 10 tablets, the median number of unconsumed tablets was 5 (IQR 0-8). For patients who were prescribed > 10 tablets, the median number of unconsumed tablets was 10 or more (open 10 [IQR 2-16], MIP 10 [IQR 2-18], MRPP 12 [IQR 5-16]). The number of tablets consumed was positively correlated with the number of tablets prescribed (Kendall's rank correlation = 0.232, p < 0.001).
Regardless of technique, for outpatient VHR with mesh, the fewer opioid tablets prescribed, the fewer tablets patients consumed. Decreasing the prescription quantity to ≤ 10 tablets, coupled with preoperative patient education, may help minimize excess opioid prescribing while still achieving adequate pain control.
尽管已努力尽量减少阿片类药物的处方，但使用补片的门诊腹疝修补术（VHR）仍然非常疼痛，通常需要术后使用阿片类镇痛药。在此，我们旨在描述构成基于补片的门诊VHR的异质性患者群体和手术的阿片类药物处方模式。
查询腹部核心健康质量协作登记处，以获取2019年1月至2023年10月期间接受补片VHR且在当天或次日出院的患者。手术根据入路和补片位置大致分类：开放手术、腹腔内补片的微创手术（MIP）以及肌后或腹膜前补片的微创手术（MRPP）。回顾了外科医生报告的阿片类药物处方数量和患者报告的30天用药数据。
在符合纳入标准的2795例患者中（46.1%为开放手术，22.7%为MIP，31.2%为MRPP），约80%的患者服用了≤10片阿片类止痛药（开放手术87.7%，MIP 78.4%，MRPP 84.2%）。对于处方量≤10片药的患者，未服用药片的中位数为5片（四分位间距0 - 8）。对于处方量>10片药的患者，未服用药片的中位数为10片或更多（开放手术10片[四分位间距² - 16]，MIP 10片[四分位间距² - 18]，MRPP 12片[四分位间距5 - 16]）。服用药片的数量与处方药片的数量呈正相关（肯德尔等级相关性 = 0.232，p < 0.001）。
无论采用何种技术，对于使用补片的门诊VHR，处方的阿片类药片越少，患者服用的药片就越少。将处方量减少至≤10片，并结合术前患者教育，可能有助于尽量减少阿片类药物的过度处方，同时仍能实现充分的疼痛控制。
