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- W2894908555 abstract "Introduction: Optimal strategies to limit inpatient exposure to opioids for postoperative pain are unclear. We aimed to characterize variations in post-pancreatectomy opioid administration in order to identify predictors of usage. Methods: Clinical characteristics and total inpatient oral morphine equivalent (OME) utilization were downloaded from electronic records for patients who underwent pancreatectomy at a single institution between 3/2016-8/2017. Regression analyses were performed to identify predictors of total usage and highest vs. lowest quartiles of OME. Results: 158 patients underwent pancreatectomy (73% pancreaticoduodenectomy, 27% distal). Transversus abdominus plane (TAP) block was performed in 80% (n = 127), almost always with intravenous patient-controlled analgesia (IV-PCA), while 15% received epidural alone. All patients received additional non-narcotic analgesics (median 2 medications). Median total OME administered was 423.2 mg (range = 0–4,362 mg). With IV-PCA users, the median OME attributable to IV-PCA alone was 373mg. Length-of-stay (LOS, p < 0.001) and no epidural (p = 0.01) were independently associated with higher total OME on linear regression. Notably, prior abdominal surgery (57.6% patients) was not associated with increased OME. Patients within the lowest/best quartile utilized ≤180mg OME, while highest/worst quartile patients utilized ≥892.5 mg. Adjusting for age, LOS, and inpatient team, only epidural (OR-3.3, p = 0.01) independently predicted lowest quartile OME on logistic regression. Longer operative time (OR 3.4, p = 0.04) and LOS (OR 1.1, p = 0.02) independently predicted highest quartile OME. Conclusions: Epidural use was associated with reduced total inpatient OME, while with TAP-block with paired IV-PCA settings represented the vast variation in total OME. These use patterns can serve as the basis for further improvements in reducing inpatient narcotic exposure." @default.
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- W2894908555 date "2018-09-01" @default.
- W2894908555 modified "2023-10-14" @default.
- W2894908555 title "Variation in and predictors of inpatient opioid utilization after pancreatectomy" @default.
- W2894908555 doi "https://doi.org/10.1016/j.hpb.2018.06.2190" @default.
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