Wiltse Nicely Kelly L, Friend Ronald, Robichaux Chad, Edwards Jonathan Alex, Cimiotti Jeannie P, Dupree Jones Kim
Certified Registered Nurse Anesthetist Program, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.
Department of Psychology, Stony Brook University, Stony Brook, New York.
Ann Thorac Surg Short Rep. 2024 Apr 23;2(4):865-870. doi: 10.1016/j.atssr.2024.04.003. eCollection 2024 Dec.
As the opioid epidemic continues, a better understanding of the use of opioids in surgery is needed. We examined whether intraoperative opioid administration was associated with greater postoperative opioid use prior to discharge in opioid-naïve patients undergoing thoracic surgery. Further, we sought to determine predictors of higher intra- and postoperative opioid use including demographic and patient factors and hospital.
Data on patients who underwent elective thoracic surgery between January 1, 2018, and December 31, 2019, were extracted from a data repository at a large health system in the Southeast United States. All patients and data on total intraoperative and postoperative (prior to discharge) opioid administration were included. A total of 126 patient encounters were analyzed.
Increased intraoperative morphine milligram equivalent was associated with increased postoperative administration, where each unit increase in intraoperative morphine milligram equivalent was associated with 0.57 increased units in postoperative use (B = 0.57; 95% CI, 0.29-0.87, < .0003), controlling for patient race, sex, age, weight, Elixhauser comorbidity score, and hospital. Younger age ( < .002), comorbidity ( < .054), and weight ( < .026) were associated with higher intra- and postoperative opioid use, but race ( < .320) and sex ( < .980) were not associated with opioid administration.
Intraoperative opioid use had a significant impact on postoperative opioid use in patients undergoing elective thoracic surgery, even when controlling for age, weight, comorbidities, race, and sex. Substantial variation in both intra- and postoperative opioid administration was noted.
随着阿片类药物流行的持续，需要更好地了解阿片类药物在手术中的使用情况。我们研究了在接受胸外科手术的未使用过阿片类药物的患者中，术中给予阿片类药物是否与出院前更高的术后阿片类药物使用量相关。此外，我们试图确定术中及术后阿片类药物使用量较高的预测因素，包括人口统计学和患者因素以及医院因素。
从美国东南部一个大型医疗系统的数据存储库中提取了2018年1月1日至2019年12月31日期间接受择期胸外科手术患者的数据。纳入了所有患者以及术中及术后（出院前）阿片类药物总使用量的数据。共分析了126例患者的病例。
术中吗啡毫克当量增加与术后给药量增加相关，在控制患者种族、性别、年龄、体重、埃利克斯豪泽合并症评分和医院因素后，术中吗啡毫克当量每增加一个单位，术后使用量增加0.57个单位（B = 0.57；95%置信区间，0.29 - 0.87，P <.0003）。年龄较小（P <.002）、合并症（P <.054）和体重（P <.026）与术中及术后阿片类药物使用量较高相关，但种族（P <.320）和性别（P <.980）与阿片类药物给药无关。
即使在控制年龄、体重、合并症、种族和性别后，术中使用阿片类药物对接受择期胸外科手术患者的术后阿片类药物使用仍有显著影响。术中及术后阿片类药物给药均存在显著差异。
