Persistent Opioid Use After Hospital Admission From Surgery in New Zealand: A Population-Based Study.

IF 4.6 2区 医学 Q1 ANESTHESIOLOGY
Anesthesia and analgesia Pub Date : 2024-10-01 Epub Date: 2024-09-04 DOI:10.1213/ANE.0000000000006911
Jiayi Gong, Peter Jones, Chris Frampton, Kebede Beyene, Amy Hai Yan Chan
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引用次数: 0

Abstract

Background: Persistent opioid use (POU) is common after surgery and is associated with an increased risk of mortality and morbidity. There have been no population-based studies exploring POU in opioid-naïve surgical patients in New Zealand (NZ). This study aimed to determine the incidence and risk factors for POU in opioid-naïve patients undergoing surgery in all NZ hospitals.

Method: We included all opioid-naïve patients who underwent surgery without a concomitant trauma diagnosis and received opioids after discharge from any NZ hospital between January 2007 and December 2019. Patients were considered opioid naïve if no opioids had been dispensed to them or if they did not have a prior diagnosis of an opioid-use disorder up to 365 days preceding the index date. The primary outcome was the incidence of POU, defined a priori as opioid use after discharge between 91 and 365 days. We used a multivariable logistic regression to identify risk factors for POU.

Results: We identified 1789,407 patients undergoing surgery with no concomitant diagnosis of trauma; 377,144 (21.1%) were dispensed opioids and 260,726 patients were eligible and included in the analysis. Of those included in the final sample, 23,656 (9.1%; 95% confidence interval [CI], 9.0%-9.2%) developed POU. Risk factors related to how opioids were prescribed included: changing to different opioid(s) after discharge (adjusted odds ratio [aOR], 3.21; 95% CI, 3.04-3.38), receiving multiple opioids on discharge (aOR, 1.37; 95% CI, 1.29-1.45), and higher total oral morphine equivalents (>400 mg) (aOR, 1.23; 95% CI, 1.23-1.45). Conversely, patients who were coprescribed nonopioid analgesics on discharge had lower odds of POU (aOR, 0.91; 95% CI, 0.87-0.95). Only small differences were observed between different ethnicities. Other risk factors associated with increased risk of POU included undergoing neurosurgery (aOR, 2.02; 95% CI, 1.83-2.24), higher comorbidity burden (aOR, 1.90; 95% CI, 1.75-2.07), preoperative nonopioid analgesic use (aOR, 1.65; 95% CI, 1.60-1.71), smoking (aOR, 1.44; 95% CI, 1.35-1.54), and preoperative hypnotics use (aOR, 1.35; 95% CI, 1.28-1.42).

Conclusions: Approximately 1 in 11 opioid-naïve patients who were dispensed opioids on surgical discharge, developed POU. Potentially modifiable risk factors for POU, related to how opioids were prescribed included changing opioids after discharge, receiving multiple opioids, and higher total dose of opioids given on discharge. Clinicians should discuss the possibility of developing POU with patients before and after surgery and consider potentially modifiable risk factors for POU when prescribing analgesia on discharge after surgery.

新西兰外科手术入院后阿片类药物的持续使用:基于人群的研究
背景:术后持续使用阿片类药物(POU)很常见,并与死亡率和发病率的增加有关。目前还没有基于人群的研究对新西兰(NZ)未使用过阿片类药物的手术患者进行持续使用阿片类药物的调查。本研究旨在确定在新西兰所有医院接受手术的阿片类药物无效患者中POU的发生率和风险因素:我们纳入了2007年1月至2019年12月期间在新西兰任何一家医院接受手术且未同时确诊外伤并在出院后接受阿片类药物治疗的所有阿片类药物无效患者。如果患者在索引日期前365天内未获得过阿片类药物配给,或之前未诊断出阿片类药物使用障碍,则被视为阿片类药物天真患者。主要结果是 POU 的发生率,先验定义为出院后 91 天至 365 天内阿片类药物的使用情况。我们使用多变量逻辑回归来确定 POU 的风险因素:我们确定了 1789,407 名接受手术且未同时诊断为外伤的患者;377,144 人(21.1%)获得了阿片类药物处方,260,726 名患者符合条件并纳入分析。在纳入最终样本的患者中,有23656人(9.1%;95%置信区间[CI],9.0%-9.2%)出现了POU。与阿片类药物处方方式相关的风险因素包括:出院后更换为不同的阿片类药物(调整后的几率比[aOR],3.21;95% CI,3.04-3.38)、出院时接受多种阿片类药物(aOR,1.37;95% CI,1.29-1.45)以及较高的口服吗啡总当量(>400 毫克)(aOR,1.23;95% CI,1.23-1.45)。相反,出院时获得非阿片类镇痛药处方的患者发生 POU 的几率较低(aOR,0.91;95% CI,0.87-0.95)。不同种族之间的差异很小。与 POU 风险增加相关的其他风险因素包括:接受神经外科手术(aOR,2.02;95% CI,1.83-2.24)、较高的并发症负担(aOR,1.90;95% CI,1.75-2.07)、术前非手术镇痛(aOR,0.91;95% CI,0.87-0.95)、术后镇痛(aOR,0.91;95% CI,0.87-0.95)。结论:术前使用非阿片类镇痛药(aOR,1.65;95% CI,1.60-1.71)、吸烟(aOR,1.44;95% CI,1.35-1.54)和术前使用催眠药(aOR,1.35;95% CI,1.28-1.42):每11名未使用过阿片类药物的患者中就有1人在手术出院时使用阿片类药物,并出现POU。与阿片类药物处方方式有关的潜在可调整风险因素包括出院后更换阿片类药物、接受多种阿片类药物以及出院时阿片类药物总剂量较高。临床医生应在手术前后与患者讨论发生 POU 的可能性,并在手术后出院时开具镇痛处方时考虑发生 POU 的潜在可调节风险因素。
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来源期刊
Anesthesia and analgesia
Anesthesia and analgesia 医学-麻醉学
CiteScore
9.90
自引率
7.00%
发文量
817
审稿时长
2 months
期刊介绍: Anesthesia & Analgesia exists for the benefit of patients under the care of health care professionals engaged in the disciplines broadly related to anesthesiology, perioperative medicine, critical care medicine, and pain medicine. The Journal furthers the care of these patients by reporting the fundamental advances in the science of these clinical disciplines and by documenting the clinical, laboratory, and administrative advances that guide therapy. Anesthesia & Analgesia seeks a balance between definitive clinical and management investigations and outstanding basic scientific reports. The Journal welcomes original manuscripts containing rigorous design and analysis, even if unusual in their approach.
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