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Opioid-free colorectal surgery: a method to improve patient & financial outcomes in surgery

机译：无面积结直肠手术：一种改善手术中患者和金融结果的方法

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BackgroundOpioids are a mainstay for postsurgical pain management, but have associated complications and costs, and contribute to the opioid epidemic. While efforts to reduce opioid use exist, little study has been done on opioid utilization and its impact across surgical approaches. Our goal was to evaluate the impact of opioid utilization on quality measures and costs after open and laparoscopic colorectal surgery.MethodsThe Premier database was reviewed for inpatient colorectal procedures from January 01, 2014, to September 30, 2015. Procedures were stratified into open and laparoscopic approaches, then opioid and opioid-free groups within each approach. Univariate analysis compared demographics, outcomes, and cost by opioid use and surgical approach. In the opioid groups, opioid consumption and duration were assessed across platforms. Multivariate regression analyzed the association between opioid use and surgical approach on costs and quality outcomes.Results50,098 procedures were evaluated40.4% laparoscopic and 59.6% open. 6.6% of laparoscopic and 5.3% of open cases were opioid free. Across both approaches, patients over 65 were most likely opioid free, while the obese and cancer patients were most likely to use opioids. Length of stay was shorter, and post-discharge nursing needs and total costs were lower in the opioid-free group in both approaches (all p<0.001). The median daily and total opioid consumption were lower with a laparoscopic approach (p<0.001), which also had a shorter duration of use versus open cases (p<0.001). Opioids were 20% more likely in open cases. Total costs were 16% greater with opioids and 24% greater in open surgery. Complications were 89% more likely in open surgery. Readmissions were increased by 14% with both opioid use and open surgery.ConclusionsOpioid-free colorectal surgery results in improved outcomes, and laparoscopy further improves these results. Continued efforts to increase laparoscopy are key for reducing opioids and improving outcomes as we transition to value-based care.
机译：背景产品是后勤疼痛管理的负载性，但具有相关的并发症和成本，并有助于阿片类药物流行病。虽然存在降低阿片类药物的努力存在，但对阿片类药物的利用以及跨手术方法的影响一点进行了研究。我们的目标是评估Apioid利用对开放和腹腔镜结肠直肠外科后的质量措施和成本的影响。在2014年1月1日至2015年1月30日的住院性结肠直肠程序中，审查了Premier数据库。程序分为开放和腹腔镜接近，然后在每种方法中获得阿片类药物和无阿片类药物。单变量分析比较人口统计学，结果和成本通过阿片类药物和手术方法。在阿片类药物中，在平台上评估阿片类药物消费和持续时间。多变量回归分析了阿片类药物使用与外科手术方法的关联和质量结果。结果50,098程序评估了40.4％腹腔镜和59.6％。腹腔镜6.6％的腹腔镜和5.3％的开放病例是无阿片类药物的。在两种方法中，65名患者最可能是无阿片类药物，而肥胖和癌症患者最有可能使用阿片类药物。逗留后的逗留时间较短，在两种方法中无阿片类药物群体后的护理需求和总成本较低（所有P <0.001）。每日中位数和总阿片类药物消耗量较低，腹腔镜方法（P <0.001），也具有较短的使用持续时间与打开案例（P <0.001）。在开放案件中，阿片类药物的可能性更高。在开放手术中，总成本较高16％，24％更高。开放手术中的并发症比较可能发生了89％。对于阿片类药物使用和开放手术，入伍增加了14％。无调节性的结肠直肠手术导致改善的结果，并且腹腔镜检查进一步改善了这些结果。继续努力增加腹腔镜检查是减少阿片类药物的关键，并在向基于价值的护理过渡时改善结果。

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