Opioid use following pelvic reconstructive surgery: a predictive calculator.

Autor: Palm KM; Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA., Abrams MK; Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA., Sears SB; Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA., Wherley SD; Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA., Alfahmy AM; Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA., Kamumbu SA; Case Western Reserve University School of Medicine, Cleveland, OH, USA., Wang NC; Case Western Reserve University School of Medicine, Cleveland, OH, USA., Mahajan ST; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA., El-Nashar SA; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA., Henderson JW; Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA., Hijaz AK; Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA., Mangel JM; Division of Female Pelvic Medicine and Reconstructive Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA., Pollard RR; Division of Female Pelvic Medicine and Reconstructive Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA., Rhodes SP; Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA., Sheyn D; Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA., Roberts K; Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. kasey.m.roberts@gmail.com.
Jazyk: angličtina
Zdroj: International urogynecology journal [Int Urogynecol J] 2023 Aug; Vol. 34 (8), pp. 1725-1742. Date of Electronic Publication: 2023 Jan 28.
DOI: 10.1007/s00192-022-05428-7
Abstrakt: Introduction and Hypothesis: Our objective was to evaluate the amount of opioids used by patients undergoing surgery for pelvic floor disorders and identify risk factors for opioid consumption greater than the median.
Methods: This was a prospective cohort study of 18- to 89-year-old women undergoing major urogynecological surgery between 1 November2020 and 15 October 2021. Subjects completed one preoperative questionnaire ("questionnaire 1") that surveyed factors expected to influence postoperative pain and opioid use. At approximately 1 and 2 weeks following surgery, patients completed two additional questionnaires ("questionnaire 2" and "questionnaire 3") about their pain scores and opioid use. Risk factors for opioid use greater than the median were assessed. Finally, a calculator was created to predict the amount of opioid used at 1 week following surgery.
Results: One hundred and ninety patients were included. The median amount of milligram morphine equivalents prescribed was 100 (IQR 100-120), whereas the median amount used by questionnaire 2 was 15 (IQR 0-50) and by questionnaire 3 was 20 (IQR 0-75). On multivariate logistic regression, longer operative time (aOR 1.64 per hour of operative time, 95% CI 1.07-2.58) was associated with using greater than the median opioid consumption at the time of questionnaire 2; whereas for questionnaire 3, a diagnosis of fibromyalgia (aOR=16.9, 95% CI 2.24-362.9) was associated. A preliminary calculator was created using the information collected through questionnaires and chart review.
Conclusions: Patients undergoing surgery for pelvic floor disorders use far fewer opioids than they are prescribed.
(© 2023. The International Urogynecological Association.)
Databáze: MEDLINE
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