Post-discharge opioid use and handling in surgical patients: A multicentre prospective cohort study
Post-discharge opioid use and handling in surgical patients: A multicentre prospective cohort study
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DOI：
10.1177/0310057x19895019
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发表时间：
2020-01-01
影响因子：
1.5
通讯作者：
Williams, Daryl L.
中科院分区：
文献类型：
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作者：
Allen, Megan L.;Kim, Charles C.;Williams, Daryl L.
我们的目的是确定术后阿片类药物处方的频率和特征，并描述患者对出院阿片类药物的处理。我们进行了一项多中心前瞻性队列研究，研究对象是接受选择性或紧急手术、术后住院一晚或多晚的成年患者，并在出院后两周进行电话随访。主要结局指标包括出院时阿片类药物处方比例、出院后阿片类药物使用比例、阿片类药物储存和处置比例。在1450例符合条件的手术患者中，858例（59%，95%可信区间（CI）（57%-62%））在出院时配发了阿片类药物，其中羟考酮是最常见的药物。在581例使用阿片类药物出院并完成随访的患者中，27%的患者在出院后两周仍需要阿片类药物。在研究队列中，出院后阿片类药物的消耗变化很大。大多数（70%）患者有剩余的阿片类药物，只有一小部分（5%）报告处理了剩余的阿片类药物。在一个多变量模型中，患者的特征为年龄45岁或以下（优势比，or =1.78, 95% CI (1.36-2.33) vs年龄大于45岁），美国麻醉医师协会身体状况（ASA）评分为1或2 (or =1.96, 95% CI (1.52-2.53) vs ASA评分3至5)，较高的预期手术疼痛（or =1.45, 95% CI（1.08-1.94）重度vs中度，or =17.48, 95% CI（5.79-52.69）重度vs零/轻度）和公共资金状况(or =1.89，95% CI（1.36-2.64）相对于其他)更有可能(P
Our aim was to determine the frequency and characteristics of post-surgery prescription of opioid medication and to describe patients' handling of discharge opioid medications. We performed a multicentre prospective cohort study of adult patients undergoing elective or emergency surgery with a postoperative stay of one or more nights, with phone follow-up at two weeks after hospital discharge. The main outcome measures included the proportion of patients prescribed discharge opioid medications, post-discharge opioid use, opioid storage and disposal. Of the 1450 eligible surgical patients, opioids were dispensed on discharge to 858 (59%, 95% confidence interval (CI) (57%-62%)), with immediate-release oxycodone the most common medication. Of the 581 patients who were discharged with opioid medication and completed follow-up, 27% were still requiring opioids two weeks after discharge. Post-discharge opioid consumption was highly variable in the study cohort. The majority (70%) of patients had leftover opioids and only a small proportion (5%) reported disposal of the surplus. In a multivariate model, patients with characteristics of age 45 years or less (odds ratio, OR=1.78, 95% CI (1.36-2.33) versus older than 45 years), American Society of Anesthesiologists' physical status (ASA) scores of 1 or 2 (OR=1.96, 95% CI (1.52-2.53) versus ASA score 3 to 5), higher anticipated surgical pain (OR=1.45, 95% CI (1.08-1.94) severe versus moderate, OR=17.48, 95% CI (5.79-52.69) severe versus nil/mild) and public funding status (OR=1.89, 95% CI (1.36-2.64) versus other) were more likely (P