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Analysis of Opioid Use in Patients Undergoing Open Versus Robotic Gastrectomy

  • Gastrointestinal Oncology
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Minimally invasive, robotic gastrectomy is associated with better short-term outcomes and quicker functional recovery. However, the degree to which the robotic approach influences postoperative pain and opioid use after gastrectomy is unknown. Our primary aim was to determine whether the robotic approach to gastrectomy reduces postoperative opioid use compared with the open approach.

Methods

Patients who underwent gastrectomy (November 2018 to September 2021) were identified retrospectively. Clinical characteristics, short-term surgical outcomes, oral morphine equivalent (OME) use, and pain scores were collected. Both groups were managed through an enhanced recovery program in the perioperative period.

Results

Of 81 patients, 50 underwent open and 31 underwent robotic gastrectomy. Compared with open gastrectomy patients, robotic gastrectomy patients had longer surgery time (360 vs. 288 min), less blood loss (50 vs. 138 mL), and shorter hospital stay (4 vs. 6 days) (all medians, P < 0.001). Robotic gastrectomy patients used lower OMEs on postoperative days 0–4 (all P < 0.05) and in total for days 0–4 (total mean dose 65.0 vs. 169.5 mg; P < 0.001) than did open gastrectomy patients. The robotic gastrectomy patients were prescribed a lower mean OME dose than the open gastrectomy patients (19.0 vs. 29.0 mg, respectively; P = 0.001). Multivariable analysis showed that robotic approach was associated with lower opioid use (odds ratio 3.70; 95% CI 1.01–14.3; P = 0.049).

Conclusions

Compared with open gastrectomy, robotic gastrectomy reduces opioid use in the early postoperative period and is associated with fewer OME discharge prescriptions and shorter hospital stay.

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Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgment

We thank Laura L. Russell, scientific editor, Research Medical Library, for editing this article.

Funding

Supported by the NIH/NCI under award no. P30CA016672.

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Authors and Affiliations

  1. Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Yuki Hirata MD, Russell G. Witt MD, MAS, Laura R. Prakash MD, Elsa M. Arvide PA, Kristen A. Robinson PA, Ching-Wei D. Tzeng MD, Paul Mansfield MD, Brian D. Badgwell MD, MS & Naruhiko Ikoma MD, MS

  2. Departments of Anesthesiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Vijaya Gottumukkala MD

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  1. Yuki Hirata MD
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Correspondence to Naruhiko Ikoma MD, MS.

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Disclosure

NI received a research grant from Intuitive Surgical.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and regional) and with the Helsinki Declaration of 1975 as revised in 1983. Because this was a retrospective study of deidentified patients, no informed consent was required. Ethics approval for this work was obtained.

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Hirata, Y., Witt, R.G., Prakash, L.R. et al. Analysis of Opioid Use in Patients Undergoing Open Versus Robotic Gastrectomy. Ann Surg Oncol 29, 5861–5870 (2022). https://doi.org/10.1245/s10434-022-11836-2

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