The Association of Postoperative Opioid Prescriptions with Patient Outcomes.
The Association of Postoperative Opioid Prescriptions with Patient Outcomes.
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DOI：
10.1097/sla.0000000000004965
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发表时间：
2022-12-01
影响因子：
9
通讯作者：
Bicket MC
中科院分区：
文献类型：
--
作者：
Howard R;Brown CS;Lai YL;Gunaseelan V;Chua KP;Brummett C;Englesbe M;Waljee J;Bicket MC
比较没有开阿片类药物的患者和开阿片类药物的患者手术后的结果。术后阿片类药物处方有很大的风险。了解手术后未接受阿片类药物治疗的患者的结果可能有助于降低这些风险的努力。我们对2019年1月1日至2019年10月31日期间接受手术的成年患者进行了回顾性研究。主要结果是手术后30天内急诊科就诊、再次住院或再次手术的综合发生率。次要结果是术后疼痛、满意度、生活质量和通过术后调查收集的遗憾。采用多水平、混合效应的Logistic回归分析来评估两组间的差异。在22,345名患者中，平均年龄(SD)为52.1岁(16.5岁)，其中13,269名患者(59.4%)为女性。3175例(14.2%)患者未使用阿片类药物。未处方阿片类药物的患者发生不良事件的概率相似(11.7%[95%可信区间10.2%−13.2%]vs 11.9%[95%可信区间10.6%−13.3%])。在12,872名受访者中，未开阿片类药物的患者有类似的高满意率(81.7%[95%CI 77.3%−86.1%]比81.7%[95%CI 77.7%−85.7%])和无遗憾(93.0%[95%CI 90.8%−95.2%]比92.6%[95%CI 90.4%−94.7%])，最佳生活质量(65.9%[95%CI 61.3%−70.4%]vs 63.1%[95%CI 58.4%−67.7%])和无痛感(11.5%[95%CI 8.8%−14.1%]vs 7.2%[95%CI 5.7%−8.7%])。手术后没有开阿片类药物的患者的临床和患者报告的结果与开阿片类药物的患者相似。这表明，将阿片类药物作为常规术后护理的一部分，不太可能对患者产生不利影响。
To compare outcomes after surgery between patients who were not prescribed opioids and patients who were prescribed opioids. Postoperative opioid prescriptions carry significant risks. Understanding outcomes among patients who receive no opioids after surgery may inform efforts to reduce these risks. We performed a retrospective study of adult patients who underwent surgery between January 1, 2019 and October 31, 2019. The primary outcome was the composite incidence of an emergency department visit, readmission, or reoperation within 30 days of surgery. Secondary outcomes were postoperative pain, satisfaction, quality of life, and regret collected via postoperative survey. A multilevel, mixed-effects logistic regression was performed to evaluate differences between groups. In a cohort of 22,345 patients, mean age (SD) was 52.1 (16.5) years and 13,269 (59.4%) patients were female. 3,175 (14.2%) patients were not prescribed opioids. Patients not prescribed opioids had a similar probability of adverse events (11.7% [95% CI 10.2%−13.2%] vs. 11.9% [95% CI 10.6%−13.3%]). Among 12,872 survey respondents, patients who were not prescribed an opioid had a similar rate of high satisfaction (81.7% [95% CI 77.3%−86.1%] vs. 81.7% [95% CI 77.7%−85.7%]) and no regret (93.0% [95% CI 90.8%−95.2%] vs. 92.6% [95% CI 90.4%−94.7%]), and higher rates of best quality of life (65.9% [95% CI 61.3%−70.4%] vs. 63.1% [95% CI 58.4%−67.7%]) and no pain (11.5% [95% CI 8.8%−14.1%]) vs. 7.2% [95% CI 5.7%−8.7%]). Patients who were not prescribed opioids after surgery had similar clinical and patient-reported outcomes as patients who were prescribed opioids. This suggests that minimizing opioids as part of routine postoperative care is unlikely to adversely affect patients.