因外伤入院后持续使用阿片类药物:一项基于人群的队列研究。

IF 5.9 1区 医学 Q1 ANESTHESIOLOGY
PAIN® Pub Date : 2025-01-01 Epub Date: 2024-07-03 DOI:10.1097/j.pain.0000000000003329
Jiayi Gong, Kebede Beyene, Amy Hai Yan Chan, Chris Frampton, Peter Jones
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引用次数: 0

摘要

摘要:持续使用阿片类药物(POU)是创伤后使用阿片类药物造成伤害的常见标志。本研究确定了新西兰因外伤住院的阿片类药物无效患者中持续使用阿片类药物的发生率和风险因素。这是一项基于人群的回顾性队列研究,使用的是关联数据,涉及 2007 年至 2019 年期间新西兰所有医院收治的所有年龄段的外伤患者。我们纳入了出院后接受阿片类药物治疗的所有患者,这些患者被认为是阿片类药物新患者,即在出院前365天内未接受过阿片类药物治疗或之前未被诊断出患有阿片类药物使用障碍。主要结果是 POU 的发生率,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 的独立风险因素。本研究共纳入了 177200 名患者。根据主要分析使用的标准,其中 15.3% 的患者(n = 27,060 人)出现了 POU,而敏感性分析显示 POU 的发生率在 14.3% 到 0.8% 之间。与 POU 相关的阿片类药物暴露风险因素包括:在不同阿片类药物之间转换(调整后比值比 [aOR] 2.62;95% 置信区间 [CI] 2.51-2.73)、开具多种阿片类药物处方(与可待因相比,aOR 1.44;95% CI 1.37-1.53)、使用缓释阿片类药物制剂(aOR 1.32;95% CI 1.26-1.39),以及首次出院处方总剂量较高(aOR 1.26;95% CI 1.20-1.33)。总体而言,在创伤后接触过阿片类药物的阿片类药物无效患者中,每7人中就有1人出现POU。我们的研究结果表明,临床医生在出院后继续使用阿片类药物时应注意这些因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Persistent opioid use after hospital admission due to trauma: a population-based cohort study.

Abstract: Persistent opioid use (POU) is a common marker of harm related to opioid use after trauma. This study determined the incidence and risk factors for POU after hospitalisation due to trauma in New Zealand, among opioid-naïve patients. This was a population-based, retrospective cohort study, using linked data, involving all trauma patients of any age admitted to all NZ hospitals between 2007 and 2019. We included all patients who received opioids after discharge and were considered opioid naïve, defined as not having received opioids or not having a prior diagnosis of opioid-use disorder up to 365 days preceding the discharge date. The primary outcome was the incidence of POU defined as opioid use after discharge between 91 and 365 days. We used a multivariable logistic regression to identify independent risk factors for POU. A total of 177,200 patients were included in this study. Of these, 15.3% (n = 27,060) developed POU based on criteria used for the primary analysis, with sensitivity analyses showing POU incidence ranging from 14.3% to 0.8%. The opioid exposure risk factors associated with POU included switching between different opioids (adjusted odds ratio [aOR] 2.62; 95% confidence interval [CI] 2.51-2.73), prescribed multiple opioids (vs codeine, aOR 1.44; 95% CI 1.37-1.53), slow-release opioid formulations (aOR 1.32; 95% CI 1.26-1.39), and dispensed higher total doses of on the initial discharge prescription (aOR 1.26; 95% CI 1.20-1.33). Overall, 1 in 7 opioid-naïve patients who were exposed to opioids after trauma developed POU. Our findings highlight clinicians should be aware of these factors when continuing opioids on discharge.

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来源期刊
PAIN®
PAIN® 医学-临床神经学
CiteScore
12.50
自引率
8.10%
发文量
242
审稿时长
9 months
期刊介绍: PAIN® is the official publication of the International Association for the Study of Pain and publishes original research on the nature,mechanisms and treatment of pain.PAIN® provides a forum for the dissemination of research in the basic and clinical sciences of multidisciplinary interest.
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