Rates of New Persistent Opioid Use After Vaginal or Cesarean Birth Among US Women
Rates of New Persistent Opioid Use After Vaginal or Cesarean Birth Among US Women
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DOI：
10.1001/jamanetworkopen.2019.7863
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发表时间：
2019-07-01
影响因子：
13.8
通讯作者：
Waljee, Jennifer F.
中科院分区：
文献类型：
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作者：
Peahl, Alex F.;Dalton, Vanessa K.;Waljee, Jennifer F.
重要性研究表明，在主要或次要程序后开具阿片类药物处方与新的持续阿片类药物使用之间存在关联。然而，阿片类药物处方与阴道分娩或剖宫产后持续使用阿片类药物的妇女之间的关联尚不清楚。目的评估阴道分娩或剖宫产后阿片类药物处方与妇女新的持续使用阿片类药物的比率之间的关联。这项回顾性队列研究使用了2008年1月1日以来来自单一私人支付者的988036名妇女的国家保险索赔数据，至2016年12月31日。参与者包括生育年龄，阿片类药物初治妇女，分娩前后连续入组1年。对于多胞胎的参与者，仅包括第一胎。EXPOSURES围产期阿片类药物处方（分娩前1周至出院后3天）由药房索赔捕获，包括处方时间和口服吗啡当量的大小。主要结果和指标新的持续阿片类药物使用率，定义为在出院后4至90天内服用一种或多种阿片类药物处方的药房索赔，以及在出院后91至365天内服用一种或多种阿片类药物处方的妇女中服用围产期阿片类药物处方的妇女。阴道分娩195013例（63.3%），剖宫产113213例（36.7%）。参与者平均（SD）年龄为31.3（5.3）岁，70567（51.0%）例为白色患者。27.0%的阴道分娩妇女和75.7%的剖腹产妇女使用了围产期阿片类药物处方。其中，1.7%的阴道分娩者和2.2%的剖宫产者有新的持续阿片类药物使用。相比之下，在未接受围产期阿片类药物处方的女性中，0.5%的阴道分娩和1.0%的剖宫产有新的持续阿片类药物使用。从2008年到2016年，阴道分娩的阿片类药物处方填充率从26.9%下降到23.8%（P
IMPORTANCE Research has shown an association between opioid prescribing after major or minor procedures and new persistent opioid use. However, the association of opioid prescribing with persistent use among women after vaginal delivery or cesarean delivery is less clear.OBJECTIVE To assess the association between opioid prescribing administered for vaginal or cesarean delivery and rates of new persistent opioid use among women.DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used national insurance claims data for 988 036 women from a single private payer from January 1, 20 08, to December 31, 2016. Participants included reproductive age, opioid-naive women with 1 year of continuous enrollment before and after delivery. For participants with multiple births, only the first birth was included.EXPOSURES Peripartum opioid prescription (1 week before delivery to 3 days after discharge) captured by pharmacy claims, including prescription timing and size in oral morphine equivalents. Multi variable adjusted odds ratios were estimated using regression models.MAIN OUTCOMES AND MEASURES Rates of new persistent opioid use, defined as pharmacy claims for 1 or more opioid prescription 4 to 90 days after discharge and 1 or more prescription 91to 365 days after discharge among women who filled peripartum opioid prescriptions.RESULTS In total, 308 226 deliveries were included; 195 013 (63.3%) vaginal deliveries and 113 213 (36.7%) cesarean deliveries. Participant mean (SD) age was 31.3 (5.3) years, and 70 567 (51.0%) were white patients. Peripartum opioid prescriptions were filled by 27.0% of women with vaginal deliveries and 75.7% of women with cesarean deliveries. Among them, 1.7% of those with vaginal deliveries and 2.2% with cesarean deliveries had new persistent opioid use. By contrast, among women not receiving a peripartum opioid prescription, 0.5% with vaginal delivery and 1.0% with cesarean delivery had new persistent opioid use. From 20 08 to 2016, opioid prescription fills decreased for vaginal deliveries from 26.9% to 23.8% (P