Factors Associated With Opioid Use in Patients Hospitalized for Acute Pancreatitis
Factors Associated With Opioid Use in Patients Hospitalized for Acute Pancreatitis
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DOI：
10.1001/jamanetworkopen.2019.1827
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发表时间：
2019-04-01
影响因子：
13.8
通讯作者：
Chen, Wansu
中科院分区：
文献类型：
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作者：
Wu, Bechien U.;Butler, Rebecca K.;Chen, Wansu
重要性：关于急性胰腺炎（AP）疼痛的最佳治疗方法的指导有限。目的：调查阿片类药物用于治疗急性疼痛住院AP患者的变异性来源，并探讨阿片类药物处方模式与住院时间的潜在关联。设计、环境和参与者：本回顾性队列研究包括2008年1月1日至2015年6月30日在社区综合卫生保健系统中住院的4307例18岁及以上的AP患者。分析开始于2017年11月。暴露：阿片类药物使用吗啡等效剂量（MED）量化。主要结局和措施：进行了三项分析：(1)住院最初12小时内阿片类药物使用增加的相关因素（基线），(2)基线阿片类药物使用与住院时间的关系，(3)出院后90天阿片类药物使用频率（持续使用）。结果：该队列包括4307例AP患者（年龄中位数为57.4[44.0-70.2]岁；2241例女性[52.0%]）。基线时，3443例（79.9%）患者接受阿片类药物治疗，388例（9.6%）患者出院后持续使用阿片类药物。在调整疼痛和其他临床因素后，女性接受的MED少于男性（调整事件比，0.83;95% CI, 0.79-0.86; P < .001）。西班牙裔和亚裔患者接受的MED少于非西班牙裔白人患者（调整后的事件比为0.85,95% CI为0.81-0.90,P < 0.001；调整后的事件比为0.79,95% CI为0.72-0.86,P < 0.001）。酒精相关AP病因与MED与胆结石疾病增加相关（校正事件比为1.11；95% CI为1.05-1.18;P < 0.001）。与其他医院相比，13家医院中的两家提供的阿片类药物明显较少。在基线时，住院时间的中位数（四分位数范围）与MED独立相关，未接受阿片类药物治疗的患者为3.0（2.1-4.5）天，而MED最高五分位数的患者为5.0（3.2-8.7）天（P < .001）。结论和相关性：除了疼痛和疾病严重程度外，阿片类药物的使用还因AP的病因、性别、种族/民族和治疗机构而异。基线时阿片类药物使用增加与住院时间延长有关。这些发现为改善AP患者疼痛控制方法提供了机会。
IMPORTANCE: Limited guidance exists regarding the optimal approach to management of pain in acute pancreatitis (AP).OBJECTIVES: To investigate sources of variability in opioid use for treatment of acute pain in patients hospitalized for AP and to explore a potential association of opioid prescribing patterns with length of stay.DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included 4307 patients 18 years and older hospitalized for AP in a community-based integrated health care system, from January 1, 2008, to June 30, 2015. Analysis began in November 2017.EXPOSURES: Opioid use was quantified by morphine equivalent dose (MED).MAIN OUTCOMES AND MEASURES: Three analyses were performed: (1) factors associated with increased opioid administration during the initial 12 hours of hospitalization (baseline), (2) association of baseline opioid use with length of stay, and (3) frequency of opioid use 90 days after hospital discharge (persistent use).RESULTS: The cohort included 4307 patients (median [interquartile range] age, 57.4 [44.0-70.2] years; 2241 women [52.0%]) with AP. At baseline, 3443 patients (79.9%) received opioids, and 388 patients (9.6%) had persistent opioid use after discharge. After adjusting for pain and other clinical factors, women received less MED than men (adjusted event ratio, 0.83; 95% CI, 0.79-0.86; P < .001). Hispanic and Asian patients received less MED than non-Hispanic white patients (adjusted event ratio, 0.85; 95% CI, 0.81-0.90; P < .001; and adjusted event ratio, 0.79; 95% CI, 0.72-0.86; P < .001, respectively). Alcohol-related AP etiology was associated with increased MED vs gallstone disorders (adjusted event ratio, 1.11; 95% CI, 1.05-1.18; P < .001). Two of 13 hospitals administered significantly less opioids compared with the others. Median (interquartile range) length of stay was independently associated with MED at baseline, with 3.0 (2.1-4.5) days among patients not receiving opioids vs 5.0 (3.2-8.7) days among patients in the highest quintile of MED (P < .001).CONCLUSIONS AND RELEVANCE: In addition to pain and disease severity, opioid use varied by etiology of AP, sex, race/ethnicity, and institution of treatment. Increased opioid use at baseline was associated with longer hospitalization. These findings suggest opportunities for improved approaches to pain control for patients with AP.