Postoperative opioid use after lobectomy for primary lung cancer: A propensity-matched analysis of Premier hospital data

Rajaram, Ravi; Rice, David C.; Li, Yanli; Bruera, Éduardo; Liu, Emelline; Song, Chao; Oh, Daniel S.

doi:10.1016/j.jtcvs.2020.04.148

Cited by 11 publications

(13 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…26 Postoperative opioid use was lower in the RATS group than the open and VATS groups, as seen in Figures 2, 4, and 6. This was similar to the findings from a recent study by Rajaram et al, 27 who performed propensity-matched analysis on open, VATS, and RATS lobectomy patients from 2013 to 2015, using the Premier database. It is important to note that our study was not designed to compare these 3 surgical cohorts, but instead, we aimed to analyze changes in analgesic use over time within each surgical cohort.…”

Section: Discussionsupporting

confidence: 89%

Changes in analgesic strategies for lobectomy from 2009 to 2018

Schiller

Raghunathan

et al. 2021

JTCVS Open

View full text Add to dashboard Cite

Objective: To evaluate trends in the use of epidural analgesia and nonopioid and opioid analgesics for patients undergoing lobectomy from 2009 to 2018.Methods: We queried the Premier database for adult patients undergoing open, video-assisted, and robotic-assisted lobectomy from 2009 to 2018. The outcome of interest was changes in the receipt of epidural analgesia and nonopioid and opioid analgesics as measured by charges on the day of surgery. We also evaluated postoperative daily opioid use. We used multivariable logistic and linear regression models to examine the association between the utilization of each analgesic modality and year.Results: We identified 86,308 patients undergoing lobectomy from 2009 to 2018 within the Premier database: 35,818 (41.5%) patients had open lobectomy, 35,951 (41.7%) patients had video-assisted lobectomy, and 14,539 (16.8%) patients had robotic-assisted lobectomy. For all 3 surgical cohorts, epidural analgesia use decreased, and nonopioid analgesics use increased over time, except for intravenous nonsteroidal anti-inflammatory drugs. Use of patient-controlled analgesia decreased, while opioid consumption on the day of surgery increased and postoperative opioid consumption did not decrease over time.

show abstract

Section: Discussionsupporting

confidence: 89%

Changes in analgesic strategies for lobectomy from 2009 to 2018

Schiller

Raghunathan

et al. 2021

JTCVS Open

View full text Add to dashboard Cite

show abstract

“…MIS, especially robotic-assisted surgery, has been observed to have lower post-operative opioids use across multiple clinical specialties. In an analysis of thoracic lobectomy procedures from the Premier database, robotic patients received opioids less frequently, and with lower total and average daily doses, compared to those undergoing VATS and open procedures [ 24 ]. In a similar analysis of sigmoidectomies, robotic patients were administered lower doses of parenteral opioids in comparison to open or laparoscopic patients [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Healthcare Resource Utilization After Surgical Treatment of Cancer: Value of Minimally Invasive Surgery

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background As the US healthcare system moves towards value-based care, hospitals have increased efforts to improve quality and reduce unnecessary resource use. Surgery is one of the most resource-intensive areas of healthcare and we aim to compare health resource utilization between open and minimally invasive cancer procedures. Methods We retrospectively analyzed cancer patients who underwent colon resection, rectal resection, lobectomy, or radical nephrectomy within the Premier hospital database between 2014 and 2019. Study outcomes included length of stay (LOS), discharge status, reoperation, and 30-day readmission. The open surgical approach was compared to minimally invasive approach (MIS), with subgroup analysis of laparoscopic/video-assisted thoracoscopic surgery (LAP/VATS) and robotic (RS) approaches, using inverse probability of treatment weighting. Results MIS patients had shorter LOS compared to open approach: − 1.87 days for lobectomy, − 1.34 days for colon resection, − 0.47 days for rectal resection, and − 1.21 days for radical nephrectomy (all p < .001). All MIS procedures except for rectal resection are associated with higher discharge to home rates and lower reoperation and readmission rates. Within MIS, robotic approach was further associated with shorter LOS than LAP/VATS: − 0.13 days for lobectomy, − 0.28 days for colon resection, − 0.67 days for rectal resection, and − 0.33 days for radical nephrectomy (all p < .05) and with equivalent readmission rates. Conclusion Our data demonstrate a significant shorter LOS, higher discharge to home rate, and lower rates of reoperation and readmission for MIS as compared to open procedures in patients with lung, kidney, and colorectal cancer. Patients who underwent robotic procedures had further reductions in LOS compare to laparoscopic/video-assisted thoracoscopic approach, while the reductions in LOS did not lead to increased rates of readmission.

show abstract

“…The latter study (funded by Intuitive Surgical) observed less opioid usage for robotic compared with thoracoscopic or open lobectomy. 2 In a commentary on that article, I proposed the need to tabulate many more factors contributing to postoperative thoracic surgical pain before attributing its cause. 3 Such factors as incision size, number, and location could be used to test mechanistic theories to explain why postoperative pain may differ among approaches.…”

mentioning

confidence: 99%

“…The article by Lo and colleagues 1 in this issue of JTCVS Open provides important information gained by studying clinical outcomes over time and stands as a very important companion article to that recently published by Rajaram and colleagues, 2 who used a subset from the same database. The latter study (funded by ) observed less opioid usage for robotic compared with thoracoscopic or open lobectomy.…”

mentioning

confidence: 99%