Opioid prescription levels and postoperative outcomes in orthopedic surgery-猫眼课题宝

DOI：

10.1097/j.pain.0000000000001047

发表时间：

2017-12-01

期刊：

PAIN

影响因子：

7.4

通讯作者：

中科院分区：

医学1区

文献类型：

作者：

Cozowicz, Crispiana;Olson, Ashley;Memtsoudis, Stavros G.

考虑到围手术期对阿片类药物的基本需求，我们使用骨科手术患者的人群数据调查了阿片类药物处方水平与术后结果之间的关系。我们假设阿片类药物用量的增加与术后并发症的风险增加有关。数据摘自国家高级透视数据库(2006-2013)；N=1,035,578例下关节成形术，N=220,953例脊柱融合。多水平多变量Logistic回归模型通过分配阿片类药物剂量的四分位数来研究阿片类药物处方和术后结果之间的关系。与阿片类药物剂量的最低四分之一相比，高阿片类药物处方与深静脉血栓形成和术后感染的几率显著增加约有关。50%，而尿路并发症的风险增加了23%，胃肠道和呼吸道并发症的风险增加了15%以上(P&lt；0.001)。此外，阿片类药物处方越多，住院时间(LOS)和费用分别显著增加12%和6%，P&lt；0.001。随着阿片类药物剂量的增加，脑血管并发症风险降低了25%(P=0.004)，而心肌梗死的风险保持不变。在脊柱病例中，阿片类药物处方通常较高，在LOS和费用以及胃肠道和泌尿系并发症方面观察到更强的效果。其他结果不那么明显，可能是因为样本量较小。总体而言，较高的阿片类药物处方与大多数术后并发症的增加有关，其中在血栓栓子、感染和胃肠道并发症、费用和LOS方面的影响最强。并发症风险的增加是逐步发生的，这表明存在剂量-反应梯度。

Given the basic need for opioids in the perioperative setting, we investigated associations between opioid prescription levels and postoperative outcomes using population-based data of orthopedic surgery patients. We hypothesized that increased opioid amounts would be associated with higher risk for postoperative complications. Data were extracted from the national Premier Perspective database (2006-2013); N=1,035,578 lower joint arthroplasties and N=220,953 spine fusions. Multilevel multivariable logistic regression models measured associations between opioid dose prescription and postoperative outcomes, studied by quartile of dispensed opioid dose. Compared to the lowest quartile of opioid dosing, high opioid prescription was associated with significantly increased odds for deep venous thrombosis and postoperative infections by approx. 50%, while odds were increased by 23% for urinary and more than 15% for gastrointestinal and respiratory complications (P < 0.001 respectively). Furthermore, higher opioid prescription was associated with a significant increase in length of stay (LOS) and cost by 12% and 6%, P < 0.001 respectively. Cerebrovascular complications risk was decreased by 25% with higher opioid dose (P = 0.004), while odds for myocardial infarction remained unaltered. In spine cases, opioid prescription was generally higher, with stronger effects observed for increase in LOS and cost as well as gastrointestinal and urinary complications. Other outcomes were less pronounced, possibly because of smaller sample size. Overall, higher opioid prescription was associated with an increase in most postoperative complications with the strongest effect observed in thromboembolic, infectious and gastrointestinal complications, cost, and LOS. Increase in complication risk occurred stepwise, suggesting a dose-response gradient.

Opioid prescription levels and postoperative outcomes in orthopedic surgery

文献摘要

被引文献

相似文献