Ravi Rajaram1, David C Rice2, Yanli Li3, Eduardo Bruera4, Emelline Liu3, Chao Song3, Daniel S Oh5. 1. Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex. Electronic address: rrajaram@mdanderson.org. 2. Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex. 3. Health Economics and Outcomes Research, Intuitive Surgical, Sunnyvale, Calif. 4. Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Tex. 5. Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif.
Abstract
OBJECTIVE: To evaluate opioid administration after robotic lobectomy (RL) compared with video-assisted thoracic surgery (VATS) and open lobectomy in patients with lung cancer. METHODS: Patients undergoing lobectomy for primary lung cancer between January 1, 2013, and September 30, 2015, were identified from the US Premier Hospital Perspective Database. The primary outcome was the average daily dose of opioids received from postoperative day (POD) 1 until discharge. Opioid doses were converted to morphine equivalent daily doses (MEDDs). Propensity score matching was performed to balance patient, hospital, and surgeon characteristics when comparing opioid administration by surgical approach. RESULTS: The open versus RL cohort included 2061 matched pairs, and the VATS versus RL cohort included 2142 matched pairs. From POD 1 until discharge, the patients undergoing open lobectomy had a higher rate of opioid use compared with those undergoing RL (94.8% vs 87.2%; P < .001), with a higher total dose (median MEDD, 225.0 vs 100.0; P < .001) and average daily dose (median MEDD, 41.3 vs 30.0; P < .001). Similarly, from POD 1 until discharge, patients undergoing VATS lobectomy had a slightly higher rate of opioid use compared with those undergoing RL (89.6% vs 87.0%; P = .008), with a higher total dose (median MEDD, 130.0 vs 100.0; P < .001) and average daily dose (median MEDD, 33.8 vs 28.8; P < .001). CONCLUSIONS: Patients undergoing RL for primary lung cancer received opioids less frequently, and with lower total and average daily doses, compared with those undergoing VATS and open lobectomy. Studies are needed to determine whether early opioid dosage reductions translate into less chronic opioid use.
OBJECTIVE: To evaluate opioid administration after robotic lobectomy (RL) compared with video-assisted thoracic surgery (VATS) and open lobectomy in patients with lung cancer. METHODS:Patients undergoing lobectomy for primary lung cancer between January 1, 2013, and September 30, 2015, were identified from the US Premier Hospital Perspective Database. The primary outcome was the average daily dose of opioids received from postoperative day (POD) 1 until discharge. Opioid doses were converted to morphine equivalent daily doses (MEDDs). Propensity score matching was performed to balance patient, hospital, and surgeon characteristics when comparing opioid administration by surgical approach. RESULTS: The open versus RL cohort included 2061 matched pairs, and the VATS versus RL cohort included 2142 matched pairs. From POD 1 until discharge, the patients undergoing open lobectomy had a higher rate of opioid use compared with those undergoing RL (94.8% vs 87.2%; P < .001), with a higher total dose (median MEDD, 225.0 vs 100.0; P < .001) and average daily dose (median MEDD, 41.3 vs 30.0; P < .001). Similarly, from POD 1 until discharge, patients undergoing VATS lobectomy had a slightly higher rate of opioid use compared with those undergoing RL (89.6% vs 87.0%; P = .008), with a higher total dose (median MEDD, 130.0 vs 100.0; P < .001) and average daily dose (median MEDD, 33.8 vs 28.8; P < .001). CONCLUSIONS:Patients undergoing RL for primary lung cancer received opioids less frequently, and with lower total and average daily doses, compared with those undergoing VATS and open lobectomy. Studies are needed to determine whether early opioid dosage reductions translate into less chronic opioid use.
Authors: Theresa Lo; Robin Schiller; Karthik Raghunathan; Vijay Krishnamoorthy; Oliver K Jawitz; Srinivas Pyati; Thomas Van De Ven; Raquel R Bartz; Annemarie Thompson; Tetsu Ohnuma Journal: JTCVS Open Date: 2021-03-26