Prevalence of Preoperative Opioid Use and Characteristics Associated With Opioid Use Among Patients Presenting for Surgery
Prevalence of Preoperative Opioid Use and Characteristics Associated With Opioid Use Among Patients Presenting for Surgery
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DOI：
10.1001/jamasurg.2018.2102
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发表时间：
2018-10-01
期刊：
影响因子：
16.9
通讯作者：
Brummett, Chad M.
中科院分区：
文献类型：
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作者：
Hilliard, Paul E.;Waljee, Jennifer;Brummett, Chad M.
术前阿片类药物使用的模式在不同的外科服务中并没有很好地表征，在这一患者群体中的研究缺乏重要的疼痛和影响的自我报告数据。目的在一个具有广泛代表性的外科队列中评估术前阿片类药物使用的流行程度和这些患者的特征。设计、环境和参与者三级医疗学术中心手术患者的横断面观察性研究。数据是作为2010年3月1日至2016年4月30日期间大型前瞻性机构研究注册的一部分收集的。术前患者和手术特征，包括前瞻性评估自我报告的疼痛和功能测量。手术前患者报告的阿片类药物使用情况。结果在招募的34186例患者中（54.2%为女性，平均[SD]年龄53.1[16.1]岁），7894例（23.1%）患者报告术前使用阿片类药物。使用最多的阿片类药物是双酒石酸氢可酮（4685例[59.4%]）、盐酸曲马多（1677例[21.2%]）和盐酸羟考酮（1442例[18.3%]）。年龄31- 40岁（校正优势比[aOR], 126; 95% CI, 1.10-1.45），吸烟（既往使用aOR， 1.32 [95% CI, 1.22-1.42]；当前使用aOR， 1.62 [95% CI, 1.48-1.78]），非法药物使用（aOR, 1.74; 95% CI, 1.16-2.60），较高的疼痛严重程度（aOR, 1.33; 95% CI, 1.31-1.35），抑郁症(aOR, 1.22；95% CI, 1.12-1.33)、较高的纤维肌痛调查评分（aOR, 1.06, 95% CI, 1.05-1.07）、较低的生活满意度（aOR, 0.95, 95% CI, 0.93-0.96）和更多的医疗合共病（美国麻醉学会评分aOR， 1.47 [95% CI, 1.37-1.58]； Charlson合共病指数aOR， 1.29 [95% CI, 1.18-1.41]）均与术前阿片类药物使用独立相关。术前阿片类药物使用在骨科（226例[65.1%]）和神经外科脊柱（596例[55.1%]）手术患者中最常见，在胸外科手术患者中最不常见（244例[15.7%]）。在调整患者特征后，接受下肢手术的患者最有可能报告术前使用阿片类药物（aOR, 3.61; 95% CI, 2.81-4.64），以及盆腔（不包括髋关节）（aOR, 3.09; 95% CI, 1.88-5.08）、上肢（aOR, 3.07; 95% CI, 2.12-4.45）、脊柱或脊髓（aOR, 2.68; 95% CI, 2.15-3.32）手术的患者，接受胸腔镜手术的组为参照组。结论和相关性在这项术前阿片类药物使用的大型研究中，包括患者报告的结果测量，超过1 / 4的手术患者报告阿片类药物使用。这些数据为这一复杂的患者群体提供了重要的见解，似乎有助于指导未来的术前优化和围手术期阿片类药物断奶干预。
IMPORTANCE Patterns of preoperative opioid use are not well characterized across different surgical services, and studies in this patient population have lacked important self-reported data of pain and affect.OBJECTIVES To assess the prevalence of preoperative opioid use and the characteristics of these patients in a broadly representative surgical cohort.DESIGN, SETTING, AND PARTICIPANTS Cross-sectional, observational study of patients undergoing surgery at a tertiary care academic medical center. Data were collected as a part of large prospective institutional research registries from March 1, 2010, through April 30, 2016.EXPOSURES Preoperative patient and procedural characteristics, including prospectively assessed self-reported pain and functional measures.MAIN OUTCOMES AND MEASURES Patient-reported opioid use before surgery.RESULTS Of the total 34 186 patients recruited (54.2% women; mean [SD] age, 53.1 [16.1] years), preoperative opioid use was reported in 7894 (23.1%). The most common opioids used were hydrocodone bitartrate (4685 [59.4%]), tramadol hydrochloride (1677 [21.2%]), and oxycodone hydrochloride (1442 [18.3%]). Age of 31to 40 years (adjusted odds ratio [aOR], 126; 95% CI, 1.10-1.45), tobacco use (former use aOR, 1.32 [95% CI, 1.22-1.42]; current use aOR, 1.62 [95% CI, 1.48-1.78]), illicit drug use (aOR, 1.74; 95% CI, 1.16-2.60), higher pain severity (aOR, 1.33; 95% CI, 1.31-1.35), depression (aOR, 1.22; 95% CI, 1.12-1.33), higher Fibromyalgia Survey scores (aOR, 1.06, 95% CI, 1.05-1.07), lower life satisfaction (aOR, 0.95, 95% CI, 0.93-0.96), and more medical comorbidities (American Society of Anesthesiology score aOR, 1.47 [95% CI, 1.37-1.58]; Charlson Comorbidity Index aOR, 1.29 [95% CI, 1.18-1.41]) were all independently associated with preoperative opioid use. Preoperative opioid use was most commonly reported by patients undergoing orthopedic (226 [65.1%]) and neurosurgical spinal (596 [55.1%]) procedures and least common among patients undergoing thoracic procedures (244 [15.7%]). After adjusting for patient characteristics, the patients undergoing lower extremity procedures were most likely to report preoperative opioid use (aOR, 3.61; 95% CI, 2.81-4.64), as well as those undergoing pelvic (excluding hip) (aOR, 3.09; 95% CI, 1.88-5.08), upper extremity (aOR, 3.07; 95% CI, 2.12-4.45), and spinal or spinal cord (aOR, 2.68; 95% CI, 2.15-3.32) procedures, with the group undergoing intrathoracic surgery as the reference group.CONCLUSIONS AND RELEVANCE In this large study of preoperative opioid use that includes patient-reported outcome measures, more than 1 in 4 patients presenting for surgery reported opioid use. These data provide important insights into this complicated patient population that would appear to help guide future preoperative optimization and perioperative opioid-weaning interventions.