Background

Preoperative opioid use in patients undergoing low complexity operations has been associated with increased complications, but its relationship to procedures of greater complexity is unclear. We aimed to assess this impact on outcomes following pancreaticoduodenectomy (PD).

Methods

A single institution, retrospective cohort of adults undergoing elective PD for cancer (1/2009-9/2015). Preoperative opioid users were defined as patients documented as taking opioids up to 90 days preoperatively. Discharge prescriptions were converted into Oral Morphine Equivalents (OME) and ten-point pain scores were abstracted. Univariate and multivariable analyses compared outcomes of naïve and preoperative opioid users overall and for laparoscopic vs open surgery.

Results

Of 661 PD patients, 131 (19.8%) were preoperative opioid users. These patients had greater mean pain scores over the first three days after surgery (3.4 ± 1.6, vs 2.8 ± 1.4, p < 0.001), max pain (7.9 ± 1.9 vs 7.2 ± 2.0, p < 0.001), and discharge pain (2.3 ± 1.9 vs 1.8 ± 1.6, p = 0.01) than naïve patients. Preoperative opioid users received more opioids at discharge (mean 496 ± 764 OME) than naïve (320 ± 489 OME, p = 0.03). Thirty-day refill rates were 12.6% (19.1% preoperative vs 10.9% naïve, p = 0.02). After controlling for tumor type, pancreas texture, and duct size, naïve patients had similar odds of clinically significant post-operative pancreatic fistulas (grade B or C) (OR 1.13, p = 0.68) and delayed gastric emptying (OR 1.05, p = 0.87). After controlling for age and complications, preoperative opioid use was associated with increased odds of LOS ≥9 days (OR 1.59, p = 0.04).

Conclusion

Following PD, preoperative opioid users had worse pain scores, received more opioids at discharge, refilled prescriptions more frequently, and were more likely to have prolonged LOS. As most opioid utilization research has been focused on low complexity surgery, additional work aimed at optimizing opioid use in complex oncologic operations is warranted.

中文翻译：

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术前使用阿片类药物与胰十二指肠切除术后住院时间延长有关。

背景

接受低复杂度手术的患者术前使用阿片类药物会增加并发症，但其与更复杂手术的关系尚不清楚。我们旨在评估这种对胰十二指肠切除术 (PD) 后结局的影响。

方法

一个单一机构的回顾性队列成人接受选择性 PD 治疗癌症 (1/2009-9/2015)。术前阿片类药物使用者被定义为记录为术前服用阿片类药物长达 90 天的患者。出院处方被转换为口服吗啡当量（OME），并提取十点疼痛评分。单变量和多变量分析比较了初次和术前阿片类药物使用者的总体结果以及腹腔镜与开腹手术的结果。

结果

在 661 名 PD 患者中，131 名 (19.8%) 是术前阿片类药物使用者。这些患者在手术后的前三天具有更高的平均疼痛评分（3.4 ± 1.6，vs 2.8 ± 1.4，p < 0.001）、最大疼痛（7.9 ± 1.9 vs 7.2 ± 2.0，p < 0.001）和出院痛（2.3 ± 1.9 vs 1.8 ± 1.6, p = 0.01) 比初治患者。术前阿片类药物使用者在出院时接受了更多的阿片类药物（平均 496 ± 764 OME）而不是初次服用（320 ± 489 OME，p = 0.03）。30 天的再填充率为 12.6%（术前 19.1% 与 10.9% 天真，p = 0.02）。在控制了肿瘤类型、胰腺质地和导管大小后，初治患者出现具有临床意义的术后胰瘘（B 级或 C 级）（OR 1.13，p = 0.68）和胃排空延迟（OR 1.05，p = 0.87）。在控制了年龄和并发症后，

结论

PD 后，术前阿片类药物使用者的疼痛评分更差，出院时接受了更多的阿片类药物，更频繁地重新配药，并且更有可能延长 LOS。由于大多数阿片类药物使用研究都集中在低复杂性手术上，因此有必要开展旨在优化复杂肿瘤手术中阿片类药物使用的额外工作。