Preoperative Opioid Utilization Patterns and Postoperative Opioid Utilization: A Retrospective Cohort Study.
Preoperative Opioid Utilization Patterns and Postoperative Opioid Utilization: A Retrospective Cohort Study.
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DOI：
10.1097/aln.0000000000004026
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发表时间：
2021-12-01
期刊：
影响因子：
8.8
通讯作者：
Sun EC
中科院分区：
文献类型：
--
作者：
Rishel CA;Angst MS;Sun EC
在慢性阿片类药物使用者中，术前阿片类药物使用量的减少或增加与术后结果之间的关联尚不清楚。我们假设，降低利用率将与改善结果相关，而增加利用率将与恶化的结果相关。使用商业保险索赔，我们确定了57,019名慢性阿片类药物使用者(手术前一年提供≥10张处方或≥120天)，年龄在18-89岁之间，在2004年至2018年期间接受了十次手术中的一次。将术前7-90天至91-365d期间≥下降或增加20%的患者与变化20%(稳定利用)的患者进行比较。主要结果是术后91-365天内阿片类药物的使用。次要结果包括术后阿片类药物使用的替代指标(在此期间填写最小数量的处方)、术后不良事件和医疗保健利用。平均年龄63岁(SD13)，女性38,045例(66.7%)。术前阿片类药物使用减少12,347例(21.7%)，增加21,330例(37.4%)，稳定23,342例(40.9%)。尽管在此期间继续使用阿片类药物的患者的日均剂量相似(46.7vs.46.5毫克吗啡当量，相差0.2%，95%可信区间−0.8to1.2，P=0.684)，但在术后第91-365d，使用率下降的患者与病情稳定的患者相比，填写阿片类药物处方的可能性略低(89.2%比96.4%，OR 0.323，95%CI 0.296至0.352，P=0.001)。在此期间，93.6%的患者使用阿片类药物(OR0.57，95%CI 0.52~0.62，P<；0.001)，平均每日剂量略低(44.3毫克吗啡当量，差异−2.2，95%CI−3.1to−1.3，P<；0.001)。除了术后持续使用阿片类药物的替代措施外，二次结果在临床上没有显著差异。术前阿片类药物使用的变化与包括术后阿片类药物使用在内的几项术后结果的临床显着差异无关。
Among chronic opioid users, the association between decreasing or increasing preoperative opioid utilization and postoperative outcomes is unknown. We hypothesized that decreasing utilization would be associated with improved outcomes and increasing utilization with worsened outcomes. Using commercial insurance claims, we identified 57,019 chronic opioid users (≥10 prescriptions or ≥120 days supplied during the preoperative year), aged 18-89 undergoing one of ten surgeries between 2004 and 2018. Patients with a ≥20% decrease or increase in opioid utilization between preoperative days 7-90 and 91-365 were compared to patients with <20% change (stable utilization). The primary outcome was opioid utilization during postoperative days 91-365. Secondary outcomes included alternative measures of postoperative opioid utilization (filling a minimum number of prescriptions during this period), postoperative adverse events, and healthcare utilization. The average age was 63 (SD 13), with 38,045 (66.7%) female patients. Preoperative opioid utilization was decreasing for 12,347 (21.7%) patients, increasing for 21,330 (37.4%) patients, and stable for 23,342 (40.9%) patients. Patients with decreasing utilization were slightly less likely to fill an opioid prescription during postoperative days 91-365 compared to stable patients (89.2% vs. 96.4%, OR 0.323, 95% CI 0.296 to 0.352, p<0.001), though the average daily doses were similar among patients who continued to utilize opioids during this timeframe (46.7 vs. 46.5 morphine milligram equivalents, difference 0.2, 95% CI −0.8 to 1.2, P=0.684). 93.6% of patients with increasing utilization filled opioid prescriptions during this period (OR 0.57, 95% CI 0.52 to 0.62, p<0.001), with slightly lower average daily doses (44.3 morphine milligram equivalents, difference −2.2, 95% CI −3.1 to −1.3, P<0.001). Except for alternative measures of persistent postoperative opioid utilization, there were no clinically significant differences for the secondary outcomes. Changes in preoperative opioid utilization were not associated with clinically significant differences for several postoperative outcomes including postoperative opioid utilization.