Opioid Prescribing and Use Patterns in Postsurgical Facial Trauma Patients.
Opioid Prescribing and Use Patterns in Postsurgical Facial Trauma Patients.
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术后面部创伤患者的阿片类药物处方和使用模式。
DOI：
10.1097/prs.0000000000006588
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发表时间：
2020
影响因子：
3.6
通讯作者：
Patel,KamleshB
中科院分区：
文献类型：
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作者：
Lapidus,JodiB;Santosa,KatherineB;Skolnick,GaryB;Som,Avira;Cho,GeraldJ;Waljee,JenniferF;AuBuchon,JacobD;Patel,KamleshB
背景：面部骨折是一种疼痛的损伤，手术修复后常规使用阿片类药物治疗。研究已经确定了患者的风险因素和处方模式与阿片类药物的使用在医学和普外科，但是，鲜为人知的是，这些实体在面部trauma population.Methods：一项回顾性队列研究阿片类药物初治患者接受手术修复面部骨折进行了使用Truven健康MarketScan商业索赔和遭遇（2006年至2015年）和医疗补助多州数据库（2011年至2015年）。符合条件的手术包括鼻、鼻眶筛、眼眶、下颌骨和Le Fort骨折修复。分析阿片类药物类型、每日剂量和处方持续时间。进行多变量逻辑回归分析，以确定处方refiller.Results的独立预测因素：共20,191例接受手术修复面部骨折被确定。其中，15，861名患者（78.6%）填写了围手术期阿片类药物处方。再填充（58.7%）和潜在的不适当处方（39.4%）在这一人群中很常见。患者因素包括既往药物使用（调整后OR，1.84; 95%CI，1.63至2.07）和精神健康障碍史（调整后OR，1.43; 95%CI，1.06至1.91）是再充盈的独立预测因素。再填充的几率增加的患者处方曲马多（OR，1.98; 95%CI，1.48至2.66）和那些谁经历了多次手术修复（OR，3.38; 95%CI，2.54至4.50）。结论：再填充和潜在的不适当的处方发生在面部创伤患者进行手术修复的高利率。需要进行更多的研究，以制定该人群中适当阿片类药物处方的指南。
Background:Facial fractures are painful injuries routinely managed by opioids after surgical repair. Studies have identified patient risk factors and prescribing patterns associated with opioid use in medicine and general surgery; however, little is known about these entities in the facial trauma population.Methods:A retrospective cohort study of opioid-naive patients undergoing surgical repair of facial fractures was conducted using the Truven Health MarketScan Commercial Claims and Encounters (2006 to 2015) and Medicaid Multi-State Databases (2011 to 2015). Eligible procedures included nasal, nasoorbitoethmoid, orbital, mandible, and Le Fort fracture repair. Opioid type, daily dosage, and prescription duration were analyzed. Multivariable logistic regression was performed to determine independent predictors of prescription refill.Results:A total of 20,191 patients undergoing surgical repair of facial fractures were identified. Of these, 15,861 patients (78.6 percent) filled a perioperative opioid prescription. Refill (58.7 percent) and potentially inappropriate prescribing (39.4 percent) were common among this population. Patient factors including prior substance use (adjusted OR, 1.84; 95 percent CI, 1.63 to 2.07) and history of mental health disorder (adjusted OR, 1.43; 95 percent CI, 1.06 to 1.91) were independent predictors of refill. Increased odds of refill were seen in patients prescribed tramadol (OR, 1.98; 95 percent CI, 1.48 to 2.66) and those who underwent multiple surgical repairs (OR, 3.38; 95 percent CI, 2.54 to 4.50).Conclusions:Refill and potentially inappropriate prescribing occurred at high rates in facial trauma patients undergoing surgical repair. Additional studies are needed to develop guidelines for proper opioid prescribing in this population.