下肢搭桥术前使用加巴喷丁的病史易使患者产生阿片类药物使用和剂量依赖的高风险

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research Pub Date : 2024-10-15 DOI:10.1016/j.jss.2024.09.026

Fadi Samaan BS , Ahsan Zil-E-Ali MBBS, MPH , Billal Alamarie BS , Abdul Wasay Paracha BS , Nkemjika Nwaneri BS, MS , Faisal Aziz MD, FACS, DFSVS

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引用次数: 0

摘要

简介：本研究评估了接受下肢搭桥手术的外周动脉疾病患者术前使用加巴喷丁类药物（GBPs）与术后阿片类药物相关疾病风险之间的关系。方法：这是一项回顾性倾向评分匹配分析，研究对象是在全国多中心数据库 TriNetX 中接受外周动脉搭桥手术的患者。根据术前处方 GBPs 的病史组成两个研究组。主要结果是阿片类药物相关疾病和死亡率。结果这项研究共纳入 23706 名患者。经过倾向评分匹配分析后，每组包含 5130 名患者。主要结果显示，在 1 年和 5 年的时间点上，使用 GBPs 组和未使用 GBPs 组的术后阿片类药物相关失调明显增加：1 年结果（2.0% 对 1.1%；adj. P = 0.007）和 5 年结果（4.5% 对 3.5%；adj. P = 0.035）。逻辑回归分析显示，使用 GBPs 的患者 1 年（调整后的几率= 1.664；95% CI [1.217，2.273]，P = 0.001）和 5 年（OR = 1.353；95% CI [1.107，1.653]，P = 0.003）阿片类药物相关紊乱的几率增加。结论在接受下肢搭桥术且有加巴喷丁使用史的患者中，阿片类药物相关疾病的长期风险会增加，且呈剂量依赖性。总之，本研究强调了在处方 GBPs 用于疼痛控制的风险和益处与其阿片类药物相关疾病的长期风险以及其他不良后果之间的权衡。

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History of Preoperative Use of Gabapentin Before Lower Extremity Bypass Predisposes Patients to a High Risk of Opioid Use and Dependence in a Dose-dependent Manner

Introduction

This study assesses the association of preoperative use of gabapentinoids (GBPs) with postoperative risk of opioid-related disorders in peripheral artery disease patients undergoing lower extremity bypass operation.

Methods

This is a retrospective propensity score-matched analysis of patients undergoing peripheral artery bypass in TriNetX, a multicenter national database. Two study groups were constituted based on the preoperative history of prescribed GBPs. Primary outcomes were opioid-related disorders and mortality. The outcomes were reported at two-time endpoints that is, at 1 and 5 y.

Results

This study population included a total of 23,706 patients. After propensity score-matched analysis, each group contained 5130 patients. The primary outcomes showed a significant increase in postoperative opioid-related disorders at the 1 and 5-y time points between GBPs and no GBPs groups: 1-y outcome (2.0% versus 1.1%; adj. P = 0.007) and 5-y outcome (4.5% versus 3.5%; adj. P = 0.035). Logistic regression analysis revealed an increase in the 1-y (adjusted odds ratio= 1.664; 95% CI [1.217, 2.273], P = 0.001) and 5-y (OR = 1.353; 95% CI [1.107, 1.653], P = 0.003) odds of opioid-related disorders in patients on GBPs. A secondary analysis showed a significant dose-dependent increase in the associated risk of 5-y opioid-related disorders in patients with a history of prescribed gabapentin.

Conclusions

In patients undergoing lower extremity bypass with a history of gabapentin use, there is an associated increased long-term risk of opioid-related disorders in a dose-dependent fashion. Overall, this study highlights weighing risks and benefits of prescribing GBPs for pain control versus their long-term associated risk of opioid-related disorders among other adverse outcomes.

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来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.