Rates and risk factors for prolonged opioid use after major surgery: population based cohort study.
Rates and risk factors for prolonged opioid use after major surgery: population based cohort study.
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DOI：
10.1136/bmj.g1251
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发表时间：
2014-02-11
期刊：
影响因子：
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通讯作者：
Wijeysundera DN
中科院分区：
文献类型：
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作者：
Clarke H;Soneji N;Ko DT;Yun L;Wijeysundera DN
目的描述既往未使用阿片类药物并接受重大择期手术的患者术后长期使用阿片类药物的发生率和风险因素。设计基于人群的回顾性队列研究。设置急性护理医院在加拿大安大略，2003年4月1日至2010年3月31日。参与者39140例年龄在66岁或以上的阿片类药物初治患者，他们接受了重大择期手术，包括心脏、胸内、腹腔和盆腔手术。主要结果测量出院后阿片类药物的长期使用，定义为手术后持续的阿片类药物门诊处方超过90天。结果在整个队列的39140例患者中，49.2%（n= 19256）的患者出院时使用阿片类药物处方，3.1%（n=1229）的患者术后继续使用阿片类药物超过90天。采用多变量logistic回归模型进行风险调整后，与阿片类药物长期使用风险显著升高相关的患者相关因素包括年龄较小、家庭收入较低、特定合并症（糖尿病、心力衰竭、肺部疾病）和术前使用特定药物（苯二氮卓类、选择性5-羟色胺再摄取抑制剂、血管紧张素转换酶抑制剂）。外科手术的类型也与阿片类药物的长期使用高度相关。与开放性根治性胸外科手术相比，开放性和微创胸外科手术的风险显著更高（比值比分别为2.58，95%置信区间分别为2.03 - 3.28和1.95 - 1.36 - 2.78）。相反，开放式和微创妇科手术的风险显著降低（分别为0.73，0.55至0.98和0.45，0.33至0.62）。结论：大约3%的既往阿片类药物初治患者在重大择期手术后继续使用阿片类药物超过90天。特定的患者和手术特征与术后长期使用阿片类药物的发展相关。我们的研究结果可以帮助更好地了解阿片类药物治疗急性术后疼痛的长期风险，并定义需要干预以防止长期术后阿片类药物使用的患者亚组。
Objective To describe rates and risk factors for prolonged postoperative use of opioids in patients who had not previously used opioids and undergoing major elective surgery. Design Population based retrospective cohort study. Setting Acute care hospitals in Ontario, Canada, between 1 April 2003 and 31 March 2010. Participants 39 140 opioid naïve patients aged 66 years or older who had major elective surgery, including cardiac, intrathoracic, intra-abdominal, and pelvic procedures. Main outcome measure Prolonged opioid use after discharge, as defined by ongoing outpatient prescriptions for opioids for more than 90 days after surgery. Results Of the 39 140 patients in the entire cohort, 49.2% (n=19 256) were discharged from hospital with an opioid prescription, and 3.1% (n=1229) continued to receive opioids for more than 90 days after surgery. Following risk adjustment with multivariable logistic regression modelling, patient related factors associated with significantly higher risks of prolonged opioid use included younger age, lower household income, specific comorbidities (diabetes, heart failure, pulmonary disease), and use of specific drugs preoperatively (benzodiazepines, selective serotonin reuptake inhibitors, angiotensin converting enzyme inhibitors). The type of surgical procedure was also highly associated with prolonged opioid use. Compared with open radical prostatectomies, both open and minimally invasive thoracic procedures were associated with significantly higher risks (odds ratio 2.58, 95% confidence interval 2.03 to 3.28 and 1.95 1.36 to 2.78, respectively). Conversely, open and minimally invasive major gynaecological procedures were associated with significantly lower risks (0.73, 0.55 to 0.98 and 0.45, 0.33 to 0.62, respectively). Conclusions Approximately 3% of previously opioid naïve patients continued to use opioids for more than 90 days after major elective surgery. Specific patient and surgical characteristics were associated with the development of prolonged postoperative use of opioids. Our findings can help better inform understanding about the long term risks of opioid treatment for acute postoperative pain and define patient subgroups that warrant interventions to prevent progression to prolonged postoperative opioid use.