Fields Brittany C, Newhook Timothy E, Prakash Laura R, Arvide Elsa M, Li Zhouxuan, Tran Cao Hop S, Maxwell Jessica E, Perrier Nancy D, Katz Matthew Hg, Vauthey Jean-Nicolas, Tzeng Ching-Wei D
From the Division of Surgery, Departments of Surgical Oncology (Fields, Newhook, Prakash, Arvide, Tran Cao, Maxwell, Perrier, Katz, Vauthey, Tzeng), The University of Texas MD Anderson Cancer Center, Houston, TX.
Biostatistics (Li), The University of Texas MD Anderson Cancer Center, Houston, TX.
J Am Coll Surg. 2025 Apr 1;240(4):474-487. doi: 10.1097/XCS.0000000000001279. Epub 2025 Mar 17.
Pathway-driven, postpancreatectomy opioid reduction interventions have proven effective and sustainable and may have a "halo effect" on other major abdominal cancer operations. This study aimed to analyze the sequential effects of expanding opioid reduction efforts from pancreatectomy on opioids prescribed after hepatectomy.
This was a retrospective cohort study using data from the electronic health record and a prospective quality improvement database for consecutive hepatectomy patients (September 2016 to February 2024). Cohorts were based on 5 distinct eras of opioid-related protocol updates E1 (preintervention historical baseline): September 2016 to March 2017; E2 (introduction of 5x-multiplier): April 2017 to September 2018; E3 (departmental opioid education program): October 2018 to December 2019; E4 (initial posthepatectomy pathways): January 2020 to June 2022; and E5 (updated pancreatectomy pathways influencing hepatectomy care): July 2022 to February 2024).
Of 2,005 patients, 31% underwent major hepatectomy, 14% intermediate, 46% minor, and 9% combination surgery/other. Most (79%) patients were performed via an open approach. The median hospital stay decreased from 5 to 4 days between E1 and E5. Both intraoperative (E1, 80 mg; E5, 37 mg; p < 0.001) and total inpatient (E1 181 mg, E5 86 mg; p < 0.001) median oral morphine equivalents were reduced by >50%. A 73% reduction in discharge oral morphine equivalents was observed between E1 (225 mg) and E5 (60 mg; p < 0.001), with clinically similar median pain scores at discharge (scores 1 to 2 of 10). Concurrent universal adoption of routine 3-drug nonopioid discharge prescriptions (E1 70%, E5 98%) correlated with the proportion of patients discharged opioid-free (E1 8%, E5 43%; p < 0.001).
Directed opioid reduction efforts for pancreatectomy influenced clinically meaningful posthepatectomy reductions in inpatient and discharge opioid volumes. A "halo effect" of intradepartmental opioid reduction efforts is attainable and corresponds to measurable increases in opioid-free or nearly opioid-free discharges after major abdominal cancer surgery.
已证实，胰腺切除术后以途径为导向的阿片类药物减量干预措施有效且可持续，可能对其他主要腹部癌症手术产生“光环效应”。本研究旨在分析扩大胰腺切除术后阿片类药物减量措施对肝切除术后阿片类药物处方的后续影响。
这是一项回顾性队列研究，使用电子健康记录数据以及针对连续肝切除患者（2016年9月至2024年2月）的前瞻性质量改进数据库。队列基于阿片类药物相关方案更新的5个不同时期：E1（干预前历史基线）：2016年9月至2017年3月；E2（引入5倍乘数）：2017年4月至2018年9月；E3（科室阿片类药物教育项目）：2018年10月至2019年12月；E4（初始肝切除术后途径）：2020年1月至2022年6月；以及E5（影响肝切除护理的更新胰腺切除术后途径）：2022年7月至2024年2月。
在2005例患者中，31%接受了大肝切除术，14%为中等肝切除术，46%为小肝切除术，9%为联合手术/其他手术。大多数（79%）患者通过开放手术进行。E1至E5期间，中位住院时间从5天降至4天。术中（E1，80毫克；E5，37毫克；p<0.001）和住院期间总的（E1，181毫克；E5，86毫克；p<0.001）口服吗啡当量中位数均降低了50%以上。E1（225毫克）至E5（60毫克；p<0.001）期间，出院时口服吗啡当量减少了73%，出院时的中位疼痛评分在临床上相似（10分制中为1至2分）。常规三联非阿片类药物出院处方的同时普遍采用（E1，70%；E5，98%）与无阿片类药物出院患者的比例相关（E1，8%；E5，43%；p<0.001）。
针对胰腺切除术的阿片类药物减量措施对肝切除术后住院期间和出院时阿片类药物用量的减少具有临床意义。科室内部阿片类药物减量措施的“光环效应”是可以实现的，并且与主要腹部癌症手术后无阿片类药物或几乎无阿片类药物出院的可测量增加相对应。
