Postoperative opioid prescribing patients with diabetes: Opportunities for personalized pain management.
Postoperative opioid prescribing patients with diabetes: Opportunities for personalized pain management.
复制标题
糖尿病患者术后阿片类药物处方：个性化疼痛管理的机会。
DOI：
10.1371/journal.pone.0287697
复制
发表时间：
2023
期刊：
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
--
作者：
阿片类药物通常用于术后疼痛，但可能导致长期使用和成瘾。糖尿病损害神经功能，使疼痛管理复杂化，并使阿片类药物处方特别具有挑战性。这项回顾性观察性研究包括一个来自多地点学术卫生系统的术后患者队列，以评估2008-2019年糖尿病，疼痛和长期阿片类药物使用（POU）之间的关系。POU定义为出院后3-6个月新的阿片类药物处方。使用多变量逻辑回归控制患者因素（例如，人口统计学和临床因素，以及先前的疼痛和阿片类药物使用）。共纳入43，654例患者，其中12.4%患有糖尿病。糖尿病患者术前疼痛评分较高（2.1 vs 1.9，p<0.001），阿片类药物初治率较低（58.7% vs 68.6%，p<0.001）。手术后，尽管出院时接受了类似的阿片类药物处方，但糖尿病患者的POU发生率较高（17.7% vs 12.7%，p<0.001）。与其他患者相比，I型糖尿病患者更可能发生POU（比值比[OR]：2.22; 95%置信区间[CI]：1.69-2.90和OR：1.44，CI：1.33-1.56）。总之，即使在控制了可能的协变量后，合并糖尿病的手术患者发生POU的风险也会增加，但他们接受了相似的术后阿片类药物治疗。结果表明，更有针对性的方法来糖尿病术后疼痛管理是必要的。
Opioids are commonly prescribed for postoperative pain, but may lead to prolonged use and addiction. Diabetes impairs nerve function, complicates pain management, and makes opioid prescribing particularly challenging. This retrospective observational study included a cohort of postoperative patients from a multisite academic health system to assess the relationship between diabetes, pain, and prolonged opioid use (POU), 2008–2019. POU was defined as a new opioid prescription 3–6 months after discharge. The odds that a patient had POU was assessed using multivariate logistic regression controlling for patient factors (e.g., demographic and clinical factors, as well as prior pain and opiate use). A total of 43,654 patients were included, 12.4% with diabetes. Patients with diabetes had higher preoperative pain scores (2.1 vs 1.9, p<0.001) and lower opioid naïve rates (58.7% vs 68.6%, p<0.001). Following surgery, patients with diabetes had higher rates of POU (17.7% vs 12.7%, p<0.001) despite receiving similar opioid prescriptions at discharge. Patients with Type I diabetes were more likely to have POU compared to other patients (Odds Ratio [OR]: 2.22; 95% Confidence Interval [CI]:1.69–2.90 and OR:1.44, CI: 1.33–1.56, respectively). In conclusion, surgical patients with diabetes are at increased risk for POU even after controlling for likely covariates, yet they receive similar postoperative opiate therapy. The results suggest a more tailored approach to diabetic postoperative pain management is warranted.
登录
查看更多内容
影响因子：
4.4
作者：
Piovezan, Ronaldo D.;Kase, Camila;Poyares, Dalva
通讯作者：
Poyares, Dalva
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN
影响因子：
3.1
作者：
Ervin-Sikhondze, Brittany A.;Moser, Stephanie E.;McAfee, Jenna
通讯作者：
McAfee, Jenna
影响因子：
--
作者：
Coquet, Jean;Zammit, Alban;El Hajouji, Oualid;Humphreys, Keith;Asch, Steven M.;Osborne, Thomas F.;Curtin, Catherine M.;Hernandez-Boussard, Tina
通讯作者：
Hernandez-Boussard, Tina
影响因子：
2.9
作者：
Edwards NM;Varnum C;Overgaard S;Nikolajsen L;Christiansen CF;Pedersen AB
通讯作者：
Pedersen AB