Medicare保险患者肺癌切除术的手术入路和持续使用阿片类药物

SCI

2 March 2023

Surgical Approach and Persistent Opioid Use in Medicare Patients undergoing Lung Cancer Resection

(The Annals of Thoracic Surgery, IF: 5.102)

Nicolas Zhou, DO, MS, Jiangong Niu, PhD, David Nelson, MD, MS, Hope A.Feldman, MD, Mara B. Antonoff, MD, Wayne L. Hofstetter, MD, Reza J. Mehran, MD,David C. Rice, MBBCh, Boris Sepesi, MD, Stephen G. Swisher, MD, Garret L. Walsh,MD, Sharon H. Giordano, MD, MPH, Ravi Rajaram, MD, MSc

CORRESPONDENCE TO: rrajaram@mdanderson.org

BACKGROUND 背景  

Robotic and video-assisted thoracoscopic (VATS) approaches for lung resection are associated with decreased inpatient opioid use compared to open surgery. Whether these approaches affect outpatient persistent opioid use remains unknown.

与开放手术相比，机器人和电视辅助胸腔镜（VATS）肺切除术与住院阿片类药物使用减少相关。这些方法是否影响门诊持续使用阿片类药物仍然未知。

METHODS 方法  

Non-small cell lung cancer patients aged 66 or older who underwent lung resection between 2008 and 2017 were identified from the Surveillance, Epidemiology and End Results-Medicare database. Persistent opioid use was defined as filling an opioid prescription 3 to 6 months after lung resection. Adjusted analyses were performed to evaluate surgical approach and persistent opioid use.

从监测，流行病学和最终结果医疗保险数据库（SEER）中找到了2008年至2017年接受肺切除术的66岁或以上的非小细胞肺癌患者。持续使用阿片类药物被定义为在肺切除术后3至6个月开具阿片类药物处方。进行校正分析以评估手术入路和持续使用阿片类药物的影响。

RESULTS 结果  

We identified 19,673 patients: 7,479 (38.0%) underwent open surgery, 10,388 (52.8%) VATS, and 1,806 (9.2%) robotic. Persistent opioid use was 38% in the entire cohort, including 27% in opioid naïve patients, and highest after open surgery (42.5%), followed by VATS (35.3%) and robotic (33.1%, P<0.001). In multivariable analyses, robotic (OR:0.84, 95% CI: 0.72-0.98, P=0.028) and VATS (OR:0.87, 95% CI: 0.79-0.95, P=0.003) approaches were both associated with decreased persistent opioid use compared to open surgery in opioid naïve patients. At 12 months, patients resected using a robotic approach had the lowest OME/month compared to VATS (133 vs. 160, P<0.001) and open surgery (133 vs. 200, P<0.001). In chronic opioid patients, surgical approach was not associated with postoperative opioid use.

我们确定了19673例患者：7479例（38.0%）接受了开放手术，10388例（52.8%）接受VATS和1806例（9.2%）接受机器人手术。在整个队列中，持续使用阿片类药物的比例为38%，其中先前从未使用阿片类药物的患者为27%，开放手术后使用阿片类药物的比例最高（42.5%），其次是VATS（35.3%）和机器人（33.1%，P<0.001）。使用多变量分析，在从未使用阿片类药物的人群中，与开放手术相比，机器人手术（OR:0.84,95%CI:0.72-0.98，P=0.028）和VATS（OR:0.87,95%CI:0.79-0.95，P=0.003）手术病人使用更少的阿片类药物。在12个月时，使用机器人手术切除的患者与VATS（133 vs.160，P<0.001）和开放手术（133 vs.200，P<0.001）相比，每月的OME最低。在慢性阿片类药物使用患者中，手术方法与术后使用阿片类药物无关。

CONCLUSIONS 结论  

Persistent opioid use after lung resection is common. Both robotic and VATS approaches were associated with decreased persistent opioid use compared to open surgery in opioid naïve patients. Whether a robotic approach yields additional long-term advantages over VATS warrants further investigation.

肺切除术后持续使用阿片类药物很常见。与阿片类药物初用患者的开放手术相比，机器人和VATS方法均与持续术后使用阿片类药物的减少有关。机器人手术是否比VATS产生额外的长期优势值得进一步调查。

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