Pain and opioid prescriptions vary by procedure after breast surgery
Pain and opioid prescriptions vary by procedure after breast surgery
复制标题
DOI：
10.1002/jso.25636
复制
发表时间：
2019-07-11
影响因子：
2.5
通讯作者：
Habermann, Elizabeth B.
中科院分区：
文献类型：
--
作者：
Murphy, Brittany L.;Thiels, Cornelius A.;Habermann, Elizabeth B.
随着阿片类药物在美国的流行，评估阿片类药物处方模式至关重要。我们评估了乳房手术后出院时处方的阿片类药物及其与患者因素和疼痛评分的相关性。方法我们回顾性识别了2010年1月至2016年12月在马约诊所接受乳房切除术的成人患者。通过单变量和多变量分析比较了手术和患者因素之间的疼痛评分和处方数据。结果在4021名患者中，3782名（94.1%）接受了阿片类药物处方。所有部位特定手术组的中位口服吗啡毫克当量（MME）相似（中位数范围为225 - 375），而疼痛评分范围为1 - 4。接受双侧乳房切除术（BM）和即刻乳房再造（IBR）的患者报告的疼痛评分最高。对于接受单侧乳房切除术或BM伴淋巴结手术和IBR手术的患者，疼痛评分不随年龄或诊断而变化。在多变量分析中，与MME出院处方>Q（4）值相关的变量包括年龄、体重指数、部位、年份、住院状态和出院前疼痛>3。结论：乳房手术后患者报告的疼痛因手术而异，而处方的MME保持相似。这表明目前的阿片类药物处方不能反映疼痛的强度，需要进一步研究以优化出院阿片类药物处方实践。
Background With the opioid epidemic in the United States, evaluating opioid prescribing patterns is essential. We evaluated opioids prescribed at discharge following breast surgery and their association with patient factors and pain scores. Methods We retrospectively identified adult patients who underwent a mastectomy for cancer at Mayo Clinic sites from January 2010 to December 2016. Pain scores and prescription data were compared across operations and patient factors by univariate and multivariable analyses. Results Of 4021 patients, 3782 (94.1%) received an opioid prescription. Median oral milligram morphine equivalents (MME) were similar across all site-specific procedure groups (medians ranging from 225 to 375) while pain scores ranged from 1 to 4. Patients undergoing bilateral mastectomy (BM) and immediate breast reconstruction (IBR) reported the greatest pain scores. Pain scores did not vary with age or diagnosis for patients undergoing unilateral mastectomy or BM with lymph node surgery and IBR procedures. On multivariable analysis, variables associated with a MME discharge prescription >Q(4) values included age, body mass index, site, year, inpatient status, and pain before discharge >3. Conclusion Patient-reported pain following breast surgery varied by procedure, while MMEs prescribed remained similar. This suggests current opioid prescribing does not reflect intensity of pain and requires further research to optimize discharge opioid prescribing practices.