New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults
New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults
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DOI：
10.1001/jamasurg.2017.0504
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发表时间：
2017-06-01
期刊：
影响因子：
16.9
通讯作者：
Nallamothu, Brahmajee K.
中科院分区：
文献类型：
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作者：
Brummett, Chad M.;Waljee, Jennifer F.;Nallamothu, Brahmajee K.
重要性尽管人们越来越关注减少长期疼痛的阿片类药物处方，但对手术后持续使用阿片类药物的发生率和危险因素知之甚少。目的为了确定小手术和大手术后新的持续使用阿片类药物的发生率。设计、设置和参与者使用2013年至2014年的全国保险索赔数据集，我们确定了18至岁的美国成年人在手术前一年没有使用阿片类药物(即，在手术前12个月至1个月期间没有使用阿片类药物处方)。对于填写围手术期阿片类药物处方的患者，我们计算了在小手术(即静脉曲张切除、腹腔镜胆囊切除术、腹腔镜阑尾切除术、痔疮切除术、甲状腺切除术、经尿道前列腺手术、甲状旁腺切除术和腕管切除术)和主要外科手术(即腹侧切开疝修补术、结肠切除术、反流手术、减肥手术和子宫切除术)后，阿片类药物初治患者持续使用阿片类药物超过90天的发生率。然后，我们评估了患者水平持续使用阿片类药物的预测因素的数据。主要结果和衡量标准是在数据提取之前预先定义的主要结果。结果共有36 177例患者符合纳入标准，其中29 068例(80.3%)接受小手术治疗，7109例(19.7%)接受大手术治疗。该队列的平均年龄(SD)为44.6岁(11.9岁)，主要为女性(23913例，66.1%)和白人(26091例，72.1%)。两组新的阿片类药物持续使用率相似，从5.9%到6.5%不等。相比之下，非手术对照组的发病率仅为0.4%。与新的持续使用阿片类药物独立相关的危险因素包括：术前吸烟(调整后的优势比[AOR]，1.35；95%CI，1.21-1.49)，酒精和药物滥用障碍(AOR，1.34；95%CI，1.05-1.72)，情绪障碍(AOR，1.15；95%CI，1.01-1.30)，焦虑(AOR，1.25；95%CI，1.10-1.42)，以及术前疼痛障碍(背痛：AOR，1.57；95%CI，1.42-1.75；颈部疼痛：AOR，1.22；95%CI，1.07-1.39；关节炎：AOR，1.56；95%CI，1.40-1.73；集中性疼痛：AOR，1.39；95%CI，1.26-1.54)。结论术后新的阿片类药物持续使用是常见的，小手术和大手术之间没有显著差异，但与行为和疼痛障碍有关。这表明它的使用不是由于手术疼痛，而是可寻址的患者水平预测。新的持续使用阿片类药物是一种常见但以前未被认识到的手术并发症，值得提高认识。
IMPORTANCE Despite increased focus on reducing opioid prescribing for long-term pain, little is known regarding the incidence and risk factors for persistent opioid use after surgery.OBJECTIVE To determine the incidence of new persistent opioid use after minor and major surgical procedures.DESIGN, SETTING, AND PARTICIPANTS Using a nationwide insurance claims data set from 2013 to 2014, we identified US adults aged 18 to 64 years without opioid use in the year prior to surgery (ie, no opioid prescription fulfillments from 12 months to 1 month prior to the procedure). For patients filling a perioperative opioid prescription, we calculated the incidence of persistent opioid use for more than 90 days among opioid-naive patients after both minor surgical procedures (ie, varicose vein removal, laparoscopic cholecystectomy, laparoscopic appendectomy, hemorrhoidectomy, thyroidectomy, transurethral prostate surgery, parathyroidectomy, and carpal tunnel) and major surgical procedures (ie, ventral incisional hernia repair, colectomy, reflux surgery, bariatric surgery, and hysterectomy). We then assessed data for patient-level predictors of persistent opioid use.MAIN OUTCOMES AND MEASURES The primary outcome was defined a priori prior to data extraction. The primary outcome was new persistent opioid use, which was defined as an opioid prescription fulfillment between 90 and 180 days after the surgical procedure.RESULTS A total of 36 177 patients met the inclusion criteria, with 29 068 (80.3%) receiving minor surgical procedures and 7109 (19.7%) receiving major procedures. The cohort had a mean (SD) age of 44.6 (11.9) years and was predominately female (23 913 [66.1%]) and white (26 091 [72.1%]). The rates of new persistent opioid use were similar between the 2 groups, ranging from 5.9% to 6.5%. By comparison, the incidence in the nonoperative control cohort was only 0.4%. Risk factors independently associated with new persistent opioid use included preoperative tobacco use (adjusted odds ratio [aOR], 1.35; 95% CI, 1.21-1.49), alcohol and substance abuse disorders (aOR, 1.34; 95% CI, 1.05-1.72), mood disorders (aOR, 1.15; 95% CI, 1.01-1.30), anxiety (aOR, 1.25; 95% CI, 1.10-1.42), and preoperative pain disorders (back pain: aOR, 1.57; 95% CI, 1.42-1.75; neck pain: aOR, 1.22; 95% CI, 1.07-1.39; arthritis: aOR, 1.56; 95% CI, 1.40-1.73; and centralized pain: aOR, 1.39; 95% CI, 1.26-1.54).CONCLUSIONS AND RELEVANCE New persistent opioid use after surgery is common and is not significantly different between minor and major surgical procedures but rather associated with behavioral and pain disorders. This suggests its use is not due to surgical pain but addressable patient-level predictors. New persistent opioid use represents a common but previously underappreciated surgical complication that warrants increased awareness.