Preoperative Opioid Use is Independently Associated With Increased Costs and Worse Outcomes After Major Abdominal Surgery
Preoperative Opioid Use is Independently Associated With Increased Costs and Worse Outcomes After Major Abdominal Surgery
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DOI：
10.1097/sla.0000000000001901
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发表时间：
2017-04-01
影响因子：
9
通讯作者：
Brummett, Chad M.
中科院分区：
文献类型：
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作者：
Cron, David C.;Englesbe, Michael J.;Brummett, Chad M.
目的：探讨腹部大手术术前使用阿片类药物的临床和经济意义。背景：阿片类药物越来越多地用于治疗慢性疼痛，慢性阿片类药物使用者的围手术期护理具有挑战性。鉴于阿片类药物相关发病率和死亡率的流行，了解术前阿片类药物使用如何影响手术结果至关重要。方法：本研究分析了密歇根外科质量协作临床注册数据库中单个中心2008年至2014年的非紧急腹部盆腔手术。从术前评估的家庭用药清单中回顾性查询术前阿片类药物使用情况（二元暴露变量）。我们的主要结果是90天的总住院费用。次要结局包括住院时间、30天主要并发症发生率、出院目的地和30天再入院率。根据病例复杂性和患者特定风险因素（如人口统计学、保险、吸烟、合并症和同时使用药物）对分析进行风险调整。结果：2413例患者符合纳入标准。其中502例（21%）患者术前使用阿片类药物。协变量调整后，阿片类药物使用者（与阿片类药物初始者相比）的成本高出9.2%[95%置信区间（CI） 2.8%-15.6%；调整后是26604美元vs 24263美元；P = 0.005)，住院时间延长12.4% (95% CI 2.3%-23.5%；调整后平均5.9 vs 5.2天；P = 0.015)，并发症增加（优势比1.36;95% CI 1.04-1.78；调整后比率20% vs 16%； P = 0.023），再入院率增加（优势比1.57;95% CI 1.08-2.29；调整后比率10% vs 6%； P = 0.018），出院目的地无差异（P = 0.11）。结论：阿片类药物在腹部骨盆手术前使用是常见的，并且与术后医疗保健利用和发病率的增加独立相关。术前阿片类药物是一种潜在的可改变的危险因素，也是提高手术护理质量和价值的新目标。
Objective: To explore the clinical and financial implications of preoperative opioid use in major abdominal surgery.Background: Opioids are increasingly used to manage chronic pain, and chronic opioid users are challenging to care for perioperatively. Given the epidemic of opioid-related morbidity and mortality, it is critical to understand how preoperative opioid use impacts surgical outcomes.Methods: This was an analysis of nonemergent, abdominopelvic surgeries from 2008 to 2014 from a single center within the Michigan Surgical Quality Collaborative clinical registry database. Preoperative opioid use (binary exposure variable) was retrospectively queried from the home medication list of the preoperative evaluation. Our primary outcome was 90-day total hospital costs. Secondary outcomes included hospital length of stay, 30-day major complication rates, discharge destination, and 30-day hospital readmission rates. Analyses were risk-adjusted for case complexity and patientspecific risk factors such as demographics, insurance, smoking, comorbidities, and concurrent medication use.Results: In all, 2413 patients met the inclusion criteria. Among them, 502 patients (21%) used opioids preoperatively. After covariate adjustment, opioid users (compared with those who were opioid-naive) had 9.2% higher costs [ 95% confidence interval (CI) 2.8%-15.6%; adjusted means $26,604 vs $24,263; P = 0.005), 12.4% longer length of stay (95% CI 2.3%-23.5%; adjusted means 5.9 vs 5.2 days; P = 0.015), more complications (odds ratio 1.36; 95% CI 1.04-1.78; adjusted rates 20% vs 16%; P = 0.023), more readmissions (odds ratio 1.57; 95% CI 1.08-2.29; adjusted rates 10% vs 6%; P = 0.018), and no difference in discharge destination (P = 0.11).Conclusions: Opioid use is common before abdominopelvic surgery, and is independently associated with increased postoperative healthcare utilization and morbidity. Preoperative opioids represent a potentially modifiable risk factor and a novel target to improve quality and value of surgical care.