Changes in analgesic strategies for lobectomy from 2009 to 2018Central MessagePerspective

Theresa Lo, MD; Robin Schiller, MD, DMD; Karthik Raghunathan, MBBS, MPH; Vijay Krishnamoorthy, MD, MPH, PhD; Oliver K. Jawitz, MD, MHS; Srinivas Pyati, MBBS, MD, FCARCSI; Thomas Van De Ven, MD, PhD; Raquel R. Bartz, MD; Annemarie Thompson, MD; Tetsu Ohnuma, MD, MPH, PhD

JTCVS Open (Jun 2021)

Changes in analgesic strategies for lobectomy from 2009 to 2018Central MessagePerspective

Theresa Lo, MD,
Robin Schiller, MD, DMD,
Karthik Raghunathan, MBBS, MPH,
Vijay Krishnamoorthy, MD, MPH, PhD,
Oliver K. Jawitz, MD, MHS,
Srinivas Pyati, MBBS, MD, FCARCSI,
Thomas Van De Ven, MD, PhD,
Raquel R. Bartz, MD,
Annemarie Thompson, MD,
Tetsu Ohnuma, MD, MPH, PhD

Affiliations

Theresa Lo, MD: Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center, Durham, NC; Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC
Robin Schiller, MD, DMD: Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center, Durham, NC; Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC
Karthik Raghunathan, MBBS, MPH: Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center, Durham, NC; Division of Veterans Affairs Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC
Vijay Krishnamoorthy, MD, MPH, PhD: Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center, Durham, NC; Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC
Oliver K. Jawitz, MD, MHS: Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
Srinivas Pyati, MBBS, MD, FCARCSI: Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center, Durham, NC; Division of Veterans Affairs Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC
Thomas Van De Ven, MD, PhD: Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center, Durham, NC; Division of Veterans Affairs Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC
Raquel R. Bartz, MD: Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center, Durham, NC; Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC
Annemarie Thompson, MD: Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center, Durham, NC; Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Duke University Medical Center, Durham, NC
Tetsu Ohnuma, MD, MPH, PhD: Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University Medical Center, Durham, NC; Division of Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC; Address for reprints: Tetsu Ohnuma, MD, MPH, PhD, Department of Anesthesiology, Duke University, DUMC 3094, Durham, NC 27710.

Journal volume & issue: Vol. 6
pp. 224 – 236

Abstract

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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. Conclusions: In this large sample of patients undergoing lobectomy, utilization of epidural analgesia declined and use of nonopioid analgesics increased. Despite these changes, opioid consumption on day of surgery increased, and there was no significant reduction in postoperative opioid consumption. Further research is warranted to examine the association of these changes with patient outcomes.

Published in JTCVS Open

ISSN: 2666-2736 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Surgery
Website: https://www.journals.elsevier.com/jtcvs-open

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