手术后持续使用阿片类药物的发生率和风险因素--一项回顾性二次数据分析。

IF 6.5 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Deutsches Arzteblatt international Pub Date : 2024-11-15 DOI:10.3238/arztebl.m2024.0200

Johannes Dreiling, Norman Rose, Christin Arnold, Philipp Baumbach, Carolin Fleischmann-Struzek, Christine Kubulus, Marcus Komann, Ursula Marschall, Heike Lydia Rittner, Thomas Volk, Winfried Meißner, Daniel Schwarzkopf

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引用次数: 0

摘要

背景：在德国，术后持续使用阿片类药物（PPOU）的风险及其与手术类型的关系尚不清楚：在德国，术后持续使用阿片类药物（PPOU）的风险及其与手术类型的关系尚不清楚：我们以德国法定医疗保险公司 BARMER 的理赔数据为基础，在全国范围内开展了一项回顾性队列研究。研究纳入了 2018 年接受住院手术的未患癌症且未服用阿片类药物的成年人。手术分为 103 个类别。PPOU 被定义为术后第 1 天至第 90 天以及出院后术后第 91 天至第 180 天期间的阿片类药物处方。研究还调查了患者在手术前 12 个月内的相关风险因素。1.4% 的患者患有 PPOU（95% 置信区间 [1.4; 1.5]）。不同手术组之间存在重大差异：大截肢手术和矫形手术发生 PPOU 的风险最大。手术类型对 PPOU 风险的影响大于原有风险因素（解释方差为 22.3% 对 14.3%）。在这些因素中，酗酒和预先接受抗抑郁药物治疗与 PPOU 的最高风险相关（几率比 [OR] 1.515 [1.277; 1.797] 和 2.131 [1.943; 2.336]）：结论：PPOU 在德国的发病率较低（1.4%）。结论：PPOU 在德国的发病率较低（1.4%），手术类型对其发展起着重要作用。

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The Incidence and Risk Factors of Persis tent Opioid Use After Surgery-A Retrospective Secondary Data Analysis.

Background: The risk of persistent postoperative opioid use (PPOU) and its association with the type of surgery are still unclear in Germany.

Methods: We conducted a nationwide retrospective cohort study on the basis of claims data from BARMER, a statutory health insurance carrier in Germany. Opioid-naive adults who did not have cancer and who underwent inpatient surgery in 2018 were included in the study. The operations were divided into 103 categories. PPOU was defined as the prescribing of opioids between post - operative days 1 and 90 and also between postoperative days 91 and 180 after hospital discharge. Patient-associated risk factors in the 12 months before surgery were investigated.

Results: 203 327 patients were included. 1.4% had PPOU (95% confidence interval [1.4; 1.5]). There were major differences between operation groups: major amputations and orthopedic procedures carried the greatest risk for the development of PPOU. The type of surgery had a larger effect on the risk of PPOU than preexisting risk factors (explained variance 22.3% vs. 14.3%). Among such factors, alcohol abuse and preexisting treatment with antidepressant drugs were associated with the highest risk for PPOU (odds ratios [OR] 1.515 [1.277; 1.797] and 2.131 [1.943; 2.336]).

Conclusion: The incidence of PPOU in Germany is low (1.4%). The type of surgery plays an important role in its development.

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来源期刊

Deutsches Arzteblatt international 医学-医学：内科

CiteScore

4.10

自引率

5.20%

发文量

306

审稿时长

4-8 weeks

期刊介绍： Deutsches Ärzteblatt International is a bilingual (German and English) weekly online journal that focuses on clinical medicine and public health. It serves as the official publication for both the German Medical Association and the National Association of Statutory Health Insurance Physicians. The journal is dedicated to publishing independent, peer-reviewed articles that cover a wide range of clinical medicine disciplines. It also features editorials and a dedicated section for scientific discussion, known as correspondence. The journal aims to provide valuable medical information to its international readership and offers insights into the German medical landscape. Since its launch in January 2008, Deutsches Ärzteblatt International has been recognized and included in several prestigious databases, which helps to ensure its content is accessible and credible to the global medical community. These databases include: Carelit CINAHL (Cumulative Index to Nursing and Allied Health Literature) Compendex DOAJ (Directory of Open Access Journals) EMBASE (Excerpta Medica database) EMNursing GEOBASE (Geoscience & Environmental Data) HINARI (Health InterNetwork Access to Research Initiative) Index Copernicus Medline (MEDLARS Online) Medpilot PsycINFO (Psychological Information Database) Science Citation Index Expanded Scopus By being indexed in these databases, Deutsches Ärzteblatt International's articles are made available to researchers, clinicians, and healthcare professionals worldwide, contributing to the global exchange of medical knowledge and research.