Opioid use in thoracic surgery: a retrospective study on postoperative complications.

Autor:	Xiao J; Department of Surgery, Houston Methodist Hospital, Houston, TX, USA., Nguyen DT; Department of Pediatrics, Baylor College of Medicine, TX, USA., Lichtenberg ZK; Division of Thoracic Surgery, Houston Methodist Hospital, Houston, TX, USA., Rizk E; Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA., Meisenbach LM; Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.; Division of Thoracic Surgery, Houston Methodist Hospital, Houston, TX, USA., Chihara R; Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.; Division of Thoracic Surgery, Houston Methodist Hospital, Houston, TX, USA., Graviss EA; Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.; Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA., Kim MP; Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.; Division of Thoracic Surgery, Houston Methodist Hospital, Houston, TX, USA.
Jazyk:	angličtina
Zdroj:	Journal of thoracic disease [J Thorac Dis] 2024 Oct 31; Vol. 16 (10), pp. 6827-6834. Date of Electronic Publication: 2024 Oct 28.
DOI:	10.21037/jtd-24-825
Abstrakt:	Background: Opioids are important medications that are used to control postoperative pain. The enhanced recovery after surgery (ERAS) program has reduced opioid use after surgery. In a surgical practice with a robust ERAS program, we wanted to determine if there was a relationship between in-hospital opioid use and postoperative complications. Methods: We performed a retrospective nested case-control study of patients who underwent thoracic surgical intervention at the Houston Methodist Hospital (HMH) between 11/2020 and 11/2021 from the thoracic surgery database with hospital morphine milligram equivalent (MME) information, comparing patients who did and did not experience postoperative complications. We determined the total MME and average daily MME patients received during their hospitalization. We performed receiver operating characteristic (ROC) curve analysis with the Youden index to determine the optimal cutoff points for total MME and daily MME. We performed univariable and multivariable logistic regression analyses of the factors associated with postoperative complications. Results: A total of 419 patients were included who were mostly female (59%) and white (75%). Most patients underwent either foregut surgery (52%) or lung surgery (25%). Of the patients, 160 (38%) were on home pain medication before surgery, and 52 (12.4%) were on opioid pain medication before surgery. The median total MME during hospitalization was 73 mg, with a median average daily MME of 30 mg. There were 37 patients (8.8%) who experienced postoperative complications. Patients who had complications had a significantly higher median total MME of 135 [interquartile range (IQR) 73.0, 743.0] vs. 70 (IQR 45, 108) mg; P<0.001. Patients with a total MME ≥241 mg were more than four times more likely to have postoperative complications than those with an MME <241 mg (31.0% vs. 5.3%; P<0.001). Patients who received daily MME ≥60 mg had significantly more postoperative complications (20.0% vs. 6.8%; P=0.001). Multivariate logistic regression analysis showed that Hispanic ethnicity [odds ratio (OR) 4.33; 95% confidence interval (CI): 1.63, 11.51; P=0.003], operation duration (OR 1.01; 95% CI: 1.00, 1.01; P=0.01), and total MME (OR 1.001; 95% CI: 1.00, 1.002; P<0.001) were associated with postoperative complications. Conclusions: Hospital opioid use was associated with complications after thoracic surgical procedures. The amount of opioid medication received during hospitalization was an independent risk factor for postoperative complications in our patient population. Efforts to decrease the amount of opioid medication used with multimodal non-opioid medications may help improve surgical outcomes. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-825/coif). M.P.K. serves as an unpaid editorial board member of Journal of Thoracic Disease from September 2022 to August 2024. M.P.K. received royalties or licenses for VATS lobectomy video from Medtronic, honoria for teaching other surgeons on the use of technology from Medtronic and Intuitive Surgical. He has also consulted for Olympus. The other authors have no conflicts of interest to declare. (2024 AME Publishing Company. All rights reserved.)
Databáze:	MEDLINE
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