Evaluation of opioid discontinuation after non-orthopaedic surgery among chronic opioid users: a population-based cohort study
Evaluation of opioid discontinuation after non-orthopaedic surgery among chronic opioid users: a population-based cohort study
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DOI：
10.1016/j.bja.2019.12.006
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发表时间：
2020-03-01
影响因子：
9.8
通讯作者：
Wunsch, Hannah
中科院分区：
文献类型：
--
作者：
Jivraj, Naheed K.;Scales, Damon C.;Wunsch, Hannah
背景：许多患者在手术前长期使用阿片类药物；目前尚不清楚手术是否会改变这些患者持续使用阿片类药物的可能性。方法：我们对加拿大安大略省接受 16 项非骨科外科手术之一且长期使用阿片类药物的成年人进行了一项基于人群的匹配队列研究，定义为 (1) 与索引日期重叠的阿片类药物处方，以及 (2) 累计开具阿片类药物处方的累积天数为 120 个或以上，或之前开具的阿片类药物处方数为 10 个或以上年。根据年龄、性别、查尔森合并症指数和每日术前阿片类药物剂量，将每位手术患者与三名也是长期阿片类药物使用者的非手术患者进行匹配。主要结局是阿片类药物停药的时间。结果：该队列包括 4755 名手术患者和 14265 名匹配的非手术患者。调整社会人口学特征和合并症后，手术与阿片类药物停用的可能性增加相关（调整后的风险比：1.34，95％置信区间[CI]：1.27，1.42）。在手术患者中，与停药几率降低相关的因素包括术前平均阿片类药物剂量高于 90 吗啡毫克当量（调整后比值比 [aOR]：0.39；95% CI：0.32，0.49）或服用羟考酮处方（aOR：0.73；95% CI：0.56，0.98）。接受住院急性疼痛服务咨询（aOR：1.34；95% CI：1.06，1.69）或居住在最高社区收入五分位数（aOR：1.35；95% CI：1.04，1.79）与阿片类药物停用的可能性更大相关。结论：对于长期阿片类药物使用者，手术与阿片类药物停用的可能性增加相关。与非手术慢性阿片类药物使用者相比，第二年停止使用阿片类药物。
Background: Many patients use opioids chronically before surgery; it is unclear if surgery alters the likelihood of ongoing opioid consumption in these patients.Methods: We performed a population-based matched cohort study of adults in Ontario, Canada undergoing one of 16 non-orthopaedic surgical procedures and who were chronically using opioids, defined as (1) an opioid prescription that overlapped the index date and (2) either a total of 120 or more cumulative calendar days of filled opioid prescriptions, or 10 or more prescriptions filled in the prior year. Each surgical patient was matched based on age, sex, Charlson comorbidity index, and daily preoperative opioid dose to three non-surgical patients who were also chronic opioid users. The primary outcome was time to opioid discontinuation.Results: The cohort included 4755 surgical and 14 265 matched non-surgical patients. After adjustment for sociodemographic characteristics and comorbidities, surgery was associated with an increased likelihood of opioid discontinuation (adjusted hazard ratio: 1.34, 95% confidence interval [CI]: 1.27, 1.42). Among surgical patients, factors associated with a reduced odds of discontinuation included a mean preoperative opioid dose above 90 morphine milligram equivalents (adjusted odds ratio [aOR]: 0.39; 95% CI: 0.32, 0.49) or filling a prescription for oxycodone (aOR: 0.73; 95% CI: 0.56, 0.98). Receipt of an in-patient Acute Pain Service consultation (aOR: 1.34; 95% CI: 1.06, 1.69) or residing in the highest neighbourhood income quintile (aOR: 1.35; 95% CI: 1.04, 1.79) were associated with a greater odds of opioid discontinuation.Conclusions: For chronic opioid users, surgery was associated with an increased likelihood of discontinuation of opioids in the following year compared with non-surgical chronic opioid users.