Chronic opioid use following anterior cervical discectomy and fusion surgery for degenerative cervical pathology
Chronic opioid use following anterior cervical discectomy and fusion surgery for degenerative cervical pathology
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DOI：
10.1016/j.spinee.2019.09.011
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发表时间：
2020-01-01
期刊：
影响因子：
4.5
通讯作者：
Jain, Amit
中科院分区：
文献类型：
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作者：
Harris, Andrew B.;Marrache, Majd;Jain, Amit
背景：虽然在有限的基础上开阿片类药物控制术后疼痛是常见的做法，但很少有研究关注颈前路椎间盘切除融合术 (ACDF) 后的长期阿片类药物使用。目的：确定一级和两级 ACDF 治疗退行性颈椎病理后慢性阿片类药物使用的患病率和危险因素。设计：回顾性队列。患者样本：使用保险索赔数据库，我们确定了接受过颈椎前路切除术和融合术 (ACDF) 的 18-64 岁患者2010 年至 2015 年针对退行性颈椎病理学进行了一级或两级原发性 ACDF。 结果测量：术前和术后不同时间点的阿片类药物处方强度以及术后慢性阿片类药物使用的发展。方法：在以下时期检查阿片类药物处方使用情况：术前 90 天、术前 7 天（术前）、术前 6 天至术后 90 天（围手术期）以及术后 91 至 90 天。手术后 365 天（术后）。主要结局是术后慢性阿片类药物使用，定义为术后 3 至 12 个月内阿片类药物处方供应≥120 天或≥10 个阿片类药物处方。次要结局是高剂量（>90 吗啡毫克当量 [MME]/天）和极高剂量（>200 MME/天）阿片类药物处方。多元 Logistic 模型（ROC 曲线下面积 0.75，p
BACKGROUND CONTEXT: Although prescribing opioid medication on a limited basis for postoperative pain control is common practice, few studies have focused on chronic opioid use following anterior cervical discectomy and fusion (ACDF).PURPOSE: To determine the prevalence of and risk factors for chronic opioid use following one and two-level ACDF for degenerative cervical pathology.DESIGN: Retrospective cohort.PATIENT SAMPLE: Using an insurance claims database, we identified patients aged 18-64 who underwent one or two-level primary ACDF from 2010 to 2015 for degenerative cervical pathology.OUTCOME MEASURES: Opioid prescription strength at various timepoints pre- and postoperatively and development of chronic postoperative opioid use.METHODS: Prescription opioid use was examined during the following periods: 90 days before 7 days preceding surgery (preoperative), 6 days preceding surgery to 90 days following surgery (perioperative) and from 91 to 365 days following surgery (postoperative). The primary outcome was chronic postoperative opioid use, defined as >= 120 days' supply of opioid prescriptions filled or >= 10 opioid prescriptions between 3 and 12 months postoperatively. Secondary outcomes were high-dose (>90 morphine milligram equivalents [MME]/day) and very high-dose (>200 MME/day) opioid prescriptions. A multivariate logistic model (area under the ROC curve 0.75, p