부산대학교 도서관

Keywords Laparoscopic; Cholecystectomy; Elective; Pre-operative; Opioid; Outcomes Highlights * Nearly 25% of elective laparoscopic cholecystectomy patients have recent opioid use * Dose-response with increasing pre-op opioid use and readmission rate, hospital stay * Even one opioid prescription can increase risk for adverse post-operative outcomes * Surgeons should obtain details of pre-operative opioid use to address proactively * Expedited operation and alternative medications preferable to pre-operative opioid Abstract Background The effects of varying levels of pre-operative opioids on post-operative outcomes following elective laparoscopic cholecystectomy is largely unknown. Methods Patients who underwent elective laparoscopic cholecystectomy from 2012 to 2019 were reviewed and categorized by the number of outpatient opioid prescriptions received in the 90 days preceding surgery: none (Naïve), one (1 Rx), two (2 Rx), or three or more (Chronic). Operative time, hospital length of stay, and 30-day readmission rate were analyzed. Results Of the 11911 patients identified, 2958 (24.8%) used opioids pre-operatively. Among patients with an overnight admission, the Naïve, 1 Rx, and 2 Rx cohorts had a shorter length of stay compared to the Chronic cohort. The Naïve group had the lowest 30-day readmission rate (5.0%) followed by the 1 Rx (5.9%), 2 Rx and Chronic groups (9.1% and 8.7%, respectively) (p < 0.001). Conclusions Prevalence of pre-operative opioid use is high and warrants surgeon assessment to minimize adverse post-operative outcomes. Author Affiliation: (a) Department of General Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA (b) United States Air Force. The Views Expressed in This Paper are Those of the authors and do not Reflect the Official Policy Or Stance of the Department of the Air Force, Department of Defense, Or the U.S. Government, USA (c) Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA * Corresponding author. Department of General Surgery, Cleveland Clinic, 18099 Lorain Avenue, Suite #108, Cleveland, OH 44111. Article History: Received 23 March 2021; Revised 15 June 2021; Accepted 20 June 2021 Byline: Breanna Perlmutter (a), Elisabeth Wynia (a,b), John McMichael (a), Chao Tu (c), Judith Scheman (a), Robert Simon (a), R. Matthew Walsh (a), Toms Augustin [augustt@ccf.org] (a,*)