Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery
Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery
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DOI：
10.1007/s11999-015-4173-5
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发表时间：
2015-07-01
影响因子：
4.2
通讯作者：
Bateman, Brian T.
中科院分区：
文献类型：
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作者：
Menendez, Mariano E.;Ring, David;Bateman, Brian T.
许多接受酌情骨科手术的患者每天服用阿片类药物，无论是处方还是不适，但对高风险阿片类药物使用的流行率和影响知之甚少我们试图（1）确定接受择期骨科大手术患者阿片类药物滥用和依赖的患病率;（2）分析阿片类药物滥用和依赖与术后住院死亡率和不良事件、抢救失败、住院时间延长和非常规处置的关系;以及（3）识别与高风险阿片类药物使用相关的因素。我们使用了从全国住院患者样本中收集的出院记录中的编码数据（2002-2011年）。我们分析了阿片类药物滥用和依赖入院的患病率随时间的变化。最后，我们使用多元回归模型来衡量阿片类药物滥用和依赖与住院术后死亡率、发病率和资源利用的相关性，并确定与高风险阿片类药物使用相关的因素。阿片类药物滥用和依赖的患病率从2002年的0.095%增加到2011年的0.24%，增加了152%（p < 0.001）。阿片类药物滥用和依赖与住院死亡率增加有关（比值比[OR]，3.7; 95% CI，2.7-5.1）和总发病率（OR，2.31; 95%CI，2.2-2.4），包括诱发性精神障碍（OR，5.9; 95% CI，5.4-6.3），呼吸衰竭（OR，3.1; 95% CI，2.7-3.6），手术部位感染（OR，2.5; 95% CI，2.0-3.0），机械通气（OR，2.3; 95% CI，2.0-2.5），肺炎（OR，2.1; 95% CI，1.8-2.3），心肌梗死（OR，1.9; 95% CI，1.3-2.6）和术后肠梗阻或其他胃肠道事件（OR，1.4; 95% CI，1.3-1.6）（所有列出的实体p < 0.001）。滥用和依赖也与延长住院时间（OR，2.5; 95%CI，2.4-2.5）、非常规出院（OR，2.2; 95%CI，2.2-2.3）和抢救失败（OR，2.0; 95%CI，1.4-2.8）的风险增加相关。高风险的阿片类药物使用者更有可能是年轻，男性，非白人，有医疗保险的精神健康和物质使用障碍患者，并且正在接受脊柱手术。与医院相关的特征包括城市环境、东北部或西部的地理位置以及作为教学设施，阿片类药物滥用和依赖在整形外科住院患者中迅速增加，并与相当大的术后发病率和死亡率以及资源利用相关。我们建议整形外科医生在术前仔细筛查阿片类药物滥用的患者，帮助不适当使用阿片类药物的患者在安排择期手术前停止使用阿片类药物，拒绝对滥用阿片类药物的患者进行择期手术，并在手术时密切监测习惯于阿片类药物的患者。
Many patients having discretionary orthopaedic surgery take opioids daily, either with a prescription or illicitly, however little is known regarding the prevalence and effect of high-risk opioid use (eg, abuse, dependence) in the perioperative orthopaedic setting.We sought (1) to determine the prevalence of opioid abuse and dependence in patients undergoing major elective orthopaedic surgery; (2) to characterize the relationship of opioid abuse and dependence with in-hospital postoperative mortality and adverse events, failure to rescue, prolonged length of stay, and nonroutine disposition; and (3) to identify factors associated with high-risk opioid use.We used coding data collected in discharge records from the Nationwide Inpatient Sample (2002-2011). We analyzed changes with time in the prevalence of opioid abuse and dependence on admission. Finally, we used multivariate regression modeling to measure the association of opioid abuse and dependence with in-hospital postoperative mortality, morbidity, and resource utilization, and to identify factors associated with high-risk opioid use.The prevalence of opioid abuse and dependence increased from 0.095% in 2002 to 0.24% in 2011, an increase of 152% (p < 0.001). Opioid abuse and dependence were associated with increased inpatient mortality (odds ratio [OR], 3.7; 95% CI, 2.7-5.1) and aggregate morbidity (OR, 2.3 l; 95% CI, 2.2-2.4), including induced mental disorder (OR, 5.9; 95% CI, 5.4-6.3), respiratory failure (OR, 3.1; 95% CI, 2.7-3.6), surgical site infection (OR, 2.5; 95% CI, 2.0-3.0), mechanical ventilation (OR, 2.3; 95% CI, 2.0-2.5), pneumonia (OR, 2.1; 95% CI, 1.8-2.3), myocardial infarction (OR, 1.9; 95% CI, 1.3-2.6), and postoperative ileus or other gastrointestinal events (OR, 1.4; 95% CI, 1.3-1.6) (p < 0.001 for all listed entities). Abuse and dependence also were associated with increased risk for prolonged hospital length of stay (OR, 2.5; 95% CI, 2.4-2.5), nonroutine discharge (OR, 2.2; 95% CI, 2.2-2.3), and failure to rescue (OR, 2.0; 95% CI, 1.4-2.8). High-risk opioid users were more likely to be younger, male, nonwhite, Medicaid-insured patients with mental health and substance use disorders, and to be undergoing spine surgery. Hospital-related characteristics included urban setting, geographic location in the Northeast or West, and serving as a teaching facility.Opioid abuse and dependence are increasing rapidly among orthopaedic surgical inpatients and are associated with considerable postoperative morbidity and mortality and resource utilization. We recommend that orthopaedic surgeons screen patients carefully for opioid misuse preoperatively, help patients who are using opioids inappropriately to discontinue them before scheduling elective surgery, decline to perform elective surgery in patients who misuse opioids, and closely monitor patients who are habituated to opioids at the time they undergo surgery.Level III, prognostic study.