Association of Opioid-Related Adverse Drug Events With Clinical and Cost Outcomes Among Surgical Patients in a Large Integrated Health Care Delivery System
Association of Opioid-Related Adverse Drug Events With Clinical and Cost Outcomes Among Surgical Patients in a Large Integrated Health Care Delivery System
复制标题
DOI：
10.1001/jamasurg.2018.1039
复制
发表时间：
2018-08-01
期刊：
影响因子：
16.9
通讯作者：
Masica, Andrew L.
中科院分区：
文献类型：
--
作者：
Shafi, Shahid;Collinsworth, Ashley W.;Masica, Andrew L.
重要性阿片类药物通常用于侵入性手术期间和之后的疼痛控制。然而，阿片类药物相关的不良药物事件（ORADEs）是常见的，并已与更糟糕的患者outcome. Prostitives检查的发病率ORADEs在接受医院为基础的外科手术和内窥镜手术的患者，并评估与临床和成本outcome.Design，设置，和参与者在临床和管理数据的回顾性研究，使用国际疾病分类第九次修订版阿片类药物已知不良反应的诊断代码或通过阿片类药物拮抗剂的使用来识别ORADE。在调整潜在混杂因素后，使用多变量回归分析来衡量ORADE与结局的相关性。该研究的背景是一个大型综合医疗保健提供系统中的21家急性护理医院。研究对象为135379例患者（年龄>= 18岁，2013年1月1日至2015年9月30日入院），接受手术和内窥镜手术并给予阿片类药物。暴露阿片类药物使用，报告为吗啡毫克当量剂量。主要结局和指标阿片类药物相关的不良药物事件及其与住院患者死亡率、出院至另一护理机构、结果：在本研究的135379例成人患者（67.5%为女性）中，14386例（10.6%）至少经历过一次口服RADE。ORADE患者更可能是年龄较大、白色人种/种族、男性，并且合并症更多。口服阿片类药物的患者接受了更高的阿片类药物总剂量（中位吗啡毫克当量剂量，46.8 vs 30.0 mg; P
IMPORTANCE Opioids are commonly used for pain control during and after invasive procedures. However, opioid-related adverse drug events (ORADEs) are common and have been associated with worse patient outcomes.OBJECTIVES To examine the incidence of ORADEs in patients undergoing hospital-based surgical and endoscopic procedures and to evaluate the association of ORADEs with clinical and cost outcomes.DESIGN, SETTING, AND PARTICIPANTS In this retrospective study of clinical and administrative data, ORADEs were identified using International Classification of Diseases, Ninth Revision diagnosis codes for known adverse effects of opioids or by opioid antagonist use. Multivariable regression analysis was used to measure the association of ORADEs with outcomes after adjusting for potential confounding factors. The setting was 21 acute care hospitals in a large integrated health care delivery system. Participants were 135 379 patients (aged >= 18 years, admitted from January 1, 2013, to September 30, 2015) who underwent surgical and endoscopic procedures and were given opioids.EXPOSURE Opioid use, reported as morphine milligram equivalent doses.MAIN OUTCOMES AND MEASURES Opioid-related adverse drug events and their association with inpatient mortality, discharge to another care facility, length of stay, cost of hospitalization, and 30-day readmission.RESULTS Among 135 379 adult patients in this study (67.5% female), 14 386 (10.6%) experienced at least one ORADE. Patients with ORADEs were more likely to be older, of white race/ethnicity, and male and have more comorbidities. Patients with ORADEs received a higher total dose of opioids (median morphine milligram equivalent dose, 46.8 vs 30.0 mg; P