Association Between Preoperative Benzodiazepine Use and Postoperative Opioid Use and Health Care Costs.
Association Between Preoperative Benzodiazepine Use and Postoperative Opioid Use and Health Care Costs.
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DOI：
10.1001/jamanetworkopen.2020.18761
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发表时间：
2020-10-01
影响因子：
13.8
通讯作者：
Sun EC
中科院分区：
文献类型：
--
作者：
Rishel CA;Zhang Y;Sun EC
术前使用苯二氮卓类药物是否与术后阿片类药物使用增加以及接受手术的未使用阿片类药物的患者的医疗费用相关？在这项美国全国队列研究中，945~561 名未使用过阿片类药物的患者接受了 11 项外科手术中的 1 项，结果发现，与未使用过苯二氮卓类药物的患者相比，术前长期和间歇性使用苯二氮卓类药物的患者术后长期使用阿片类药物的风险增加。还观察到术前苯二氮卓类药物的使用与术后阿片类药物剂量增加和医疗保健费用之间的一些关联。这项研究的结果表明，在接受手术的未使用阿片类药物的患者中，术前使用苯二氮卓类药物可能会增加术后长期使用阿片类药物的风险，并可能增加医疗费用。术前苯二氮卓类药物的使用与术后长期结果之间的关系尚不清楚。描述术前苯二氮卓类药物使用与术后阿片类药物使用和医疗保健费用之间的关联。在这项队列研究中，对全美 946~561 名从未使用过阿片类药物的患者（手术前一年没有服用阿片类药物处方）的私人健康保险索赔数据进行了回顾性分析。 2004年1月1日至2016年12月31日期间，患者接受了11种常见外科手术中的1种；数据分析于2020年1月9日进行。苯二氮卓类药物的使用，定义为长期（≥10张处方配药或手术前一年内供应≥120天）或间歇性（任何不符合长期标准的使用）。主要结局是术后 91 至 365 天阿片类药物的使用情况。次要结局包括术后 0 至 90 天的阿片类药物使用情况以及术后 0 至 30 天的医疗保健费用。在这个由 946 561 名患者组成的样本中，平均年龄为 59.8 岁（范围为 18-89 岁）； 615 065 为女性（65.0%）。其中，23~484 名患者（2.5%）符合术前长期使用苯二氮卓类药物的标准，47~669 名患者（5.0%）符合间歇性使用标准。调整混杂因素后，长期（比值比 [OR]，1.59；95% CI，1.54-1.65；P < .001）和间歇性（OR，1.47；95% CI，1.44-1.51；P < .001）使用苯二氮卓类药物与术后几天使用任何阿片类药物的可能性增加相关91 至 365。对于术后第 91 至 365 天使用阿片类药物的患者，长期使用苯二氮卓类药物与阿片类药物剂量增加 44% 相关（额外增加 0.6 平均每日吗啡毫克当量 [MME]；95% CI，0.3-0.8 MME；P < .001），尽管间歇性使用苯二氮卓类药物并不显着不同（0.0 每日平均 MME；95% CI，-0.2 至 0.2 MME；P = .65）。术前苯二氮卓类药物的使用也与术后第 0 至 90 天阿片类药物的使用增加相关，无论是长期（增加 32%，平均每日 MME 额外增加 1.9 个；95% CI，1.6-2.1 MME；P < .001）和间歇性（增加 9%，平均每日 MME 额外增加 0.5 个；95% CI，0.4-0.6 MME）； P < .001) 用户。间歇性使用苯二氮卓类药物与 30 天医疗费用增加相关（1155 美元；95% CI，938-1372 美元；P < .001），而长期使用苯二氮卓类药物则没有观察到显着差异。这项研究的结果表明，在未使用阿片类药物的患者中，术前使用苯二氮卓类药物可能与长期使用阿片类药物的风险增加以及术后阿片类药物剂量的增加有关，也可能与医疗费用的增加有关。该队列研究分析了术前使用苯二氮卓类药物与术后长期使用阿片类药物的情况以及与医疗保健费用的关系。
Is preoperative benzodiazepine use associated with increased postoperative opioid use and health care costs for opioid-naive patients undergoing surgery? In this US national cohort study of 945 561 opioid-naive patients undergoing 1 of 11 surgical procedures, an increased risk for long-term opioid use postoperatively was noted in patients with both long-term and intermittent preoperative benzodiazepine use compared with benzodiazepine-naive patients. Some associations between preoperative benzodiazepine use and increased postoperative opioid dosages and health care costs were also observed. The findings of this study suggest that, among opioid-naive patients undergoing surgery, preoperative benzodiazepine use may increase the risk of postoperative long-term opioid use and may increase health care costs. The association between preoperative benzodiazepine use and long-term postoperative outcomes is not well understood. To characterize the association between preoperative benzodiazepine use and postoperative opioid use and health care costs. In this cohort study, retrospective analysis of private health insurance claims data on 946 561 opioid-naive patients (no opioid prescriptions filled in the year before surgery) throughout the US was conducted. Patients underwent 1 of 11 common surgical procedures between January 1, 2004, and December 31, 2016; data analysis was performed January 9, 2020. Benzodiazepine use, defined as long term (≥10 prescriptions filled or ≥120 days supplied in the year before surgery) or intermittent (any use not meeting the criteria for long term). The primary outcome was opioid use 91 to 365 days after surgery. Secondary outcomes included opioid use 0 to 90 days after surgery and health care costs 0 to 30 days after surgery. In this sample of 946 561 patients, the mean age was 59.8 years (range, 18-89 years); 615 065 were women (65.0%). Of these, 23 484 patients (2.5%) met the criteria for long-term preoperative benzodiazepine use and 47 669 patients (5.0%) met the criteria for intermittent use. After adjusting for confounders, long-term (odds ratio [OR], 1.59; 95% CI, 1.54-1.65; P < .001) and intermittent (OR, 1.47; 95% CI, 1.44-1.51; P < .001) benzodiazepine use were associated with an increased probability of any opioid use during postoperative days 91 to 365. For patients who used opioids in postoperative days 91 to 365, long-term benzodiazepine use was associated with a 44% increase in opioid dose (additional 0.6 mean daily morphine milligram equivalents [MMEs]; 95% CI, 0.3-0.8 MMEs; P < .001), although intermittent benzodiazepine use was not significantly different (0.0 average daily MMEs; 95% CI, −0.2 to 0.2 MMEs; P = .65). Preoperative benzodiazepine use was also associated with increased opioid use in postoperative days 0 to 90 for both long-term (32% increase, additional 1.9 average daily MMEs; 95% CI, 1.6-2.1 MMEs; P < .001) and intermittent (9% increase, additional 0.5 average daily MMEs; 95% CI, 0.4-0.6 MMEs; P < .001) users. Intermittent benzodiazepine use was associated with an increase in 30-day health care costs ($1155; 95% CI, $938-$1372; P < .001), while no significant difference was observed for long-term benzodiazepine use. The findings of this study suggest that, among opioid-naive patients, preoperative benzodiazepine use may be associated with an increased risk of developing long-term opioid use and increased opioid dosages postoperatively, and also may be associated with increased health care costs. This cohort study analyzes the preoperative use of benzodiazepines compared with long-term postoperative use of opioids and association with health care costs.
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