结直肠手术中阿片类药物潜在的相关不良反应与预后的关系
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The Association Between Potential Opioid-Related AdverseDrug Events and Outcomes in Colorectal Surgery
背景与目的
大多数结直肠手术的方法是复杂的，其可导致导致严重的术后疼痛和术后并发症。因此需要更多的证据来证明结直肠手术后阿片相关的不良药物事件(ORADE)如何影响住院时间(LOS)、医院收入以及它们之间的临床关联。通过了解结直肠手术中潜在的ORADES的临床和经济影响，我们希望进一步指导围手术期疼痛管理的方法，以改善病人的护理和降低住院费用。
方 法
我们进行了一项回顾性研究，利用医疗保险和医疗补助服务中心(CMS)管理数据库去分析涉及三个结直肠外科诊断相关组(DRGS)的医疗保险放，以确定潜在的ORADE。分析了潜在ORADE对医院平均LOS和医院收入的影响。
结 果
与无ORADE相比，结直肠手术患者的潜在ORADE率为23.92%。具有潜在ORADE的平均住院时间延长5.35天。潜在ORADE的平均每天医院的收入比没有ORADE的医院少418美元。任何一种开放手术的潜在ORADE率均明显高于腹腔镜手术(P<.001)。结直肠手术中与ORADE密切相关的临床情况包括败血症、肺炎、休克、体液和电解质紊乱。
结 论
结直肠手术中ORADEs的发生率很高，其与住院时间延长和医院收入减少有关。在围手术期减少阿片类药物的使用，例如使用多式镇痛策略，可能会导致积极的结果，如缩短住院时间，增加医院收入，增加治疗费用和改善病人护理。
原始文献摘要
Oseph Homsi, MD, Ethan Y. Brovman, MD, Nikhilesh Rao, MBA,Edward E. Whang, MD,and Richard D. Urman, MD.The Association Between Potential Opioid-Related AdverseDrug Events and Outcomes in Colorectal Surgery.J Laparoendosc Adv Surg Tech A. 2019 Sep 26. doi: 10.1089/lap.2019.0408.
Introduction: Major colorectal surgery procedures are complex operations that can result in significant postoperative pain and complications. More evidence is needed to demonstrate how opioid-related adverse drug events (ORADEs) after colorectal surgery can affect hospital length of stay (LOS), hospital revenue, and what their association is with clinical conditions. By understanding the clinical and economic impact of potential ORADEs within colorectal surgery, we hope to further guide approaches to perioperative pain management in an effort to improve patient care and reduce hospital costs.
Materials and Methods: We conducted a retrospective study utilizing the Centers for Medicare and Medicaid Services (CMS) Administrative Database to analyze Medicare discharges involving three colorectal surgery diagnosis-related groups (DRGs) to identify potential ORADEs. The impact of potential ORADEs on
mean hospital LOS and hospital revenue was analyzed.
Results: The potential ORADE rate in patients undergoing colorectal surgery was 23.92%. The mean LOS for discharges with a potential ORADE was 5.35 days longer than without an ORADE. The mean hospital revenue per day with a potential ORADE was $418 less than without an ORADE. Any type of open surgery had a statistically significant higher potential ORADE rate than the matched laparoscopic case (P < .001). Clinical conditions most strongly associated with ORADEs in colorectal surgery included septicemia, pneumonia,shock, and fluid and electrolyte disorders.
Conclusion: The incidence of ORADEs in colorectal surgery is high and is associated with longer hospital stays and reduced hospital revenue. Reducing the use of opioids in the perioperative setting, such as using multimodal analgesia strategies, may lead to positive outcomes with shorter hospital stays, increased hospital revenue, and improved patient care.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：任文鑫 编辑：何幼芹 审校：王贵龙