Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA.
Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.
Pain. 2017 Dec;158(12):2422-2430. doi: 10.1097/j.pain.0000000000001047.
Given the basic need for opioids in the perioperative setting, we investigated associations between opioid prescription levels and postoperative outcomes using population-based data of orthopedic surgery patients. We hypothesized that increased opioid amounts would be associated with higher risk for postoperative complications. Data were extracted from the national Premier Perspective database (2006-2013); N = 1,035,578 lower joint arthroplasties and N = 220,953 spine fusions. Multilevel multivariable logistic regression models measured associations between opioid dose prescription and postoperative outcomes, studied by quartile of dispensed opioid dose. Compared to the lowest quartile of opioid dosing, high opioid prescription was associated with significantly increased odds for deep venous thrombosis and postoperative infections by approx. 50%, while odds were increased by 23% for urinary and more than 15% for gastrointestinal and respiratory complications (P < 0.001 respectively). Furthermore, higher opioid prescription was associated with a significant increase in length of stay (LOS) and cost by 12% and 6%, P < 0.001 respectively. Cerebrovascular complications risk was decreased by 25% with higher opioid dose (P = 0.004), while odds for myocardial infarction remained unaltered. In spine cases, opioid prescription was generally higher, with stronger effects observed for increase in LOS and cost as well as gastrointestinal and urinary complications. Other outcomes were less pronounced, possibly because of smaller sample size. Overall, higher opioid prescription was associated with an increase in most postoperative complications with the strongest effect observed in thromboembolic, infectious and gastrointestinal complications, cost, and LOS. Increase in complication risk occurred stepwise, suggesting a dose-response gradient.
鉴于围手术期对阿片类药物的基本需求，我们使用骨科手术患者的基于人群的数据调查了阿片类药物处方量与术后结果之间的关联。我们假设增加阿片类药物的用量与术后并发症的风险增加有关。数据从国家 Premier 透视数据库（2006-2013 年）中提取；N = 1,035,578 例膝关节置换术和 N = 220,953 例脊柱融合术。多层次多变量逻辑回归模型测量了处方阿片类药物剂量与术后结果之间的关联，研究了按阿片类药物剂量分配的四分位数。与阿片类药物剂量最低的四分位数相比，高阿片类药物处方与深静脉血栓形成和术后感染的几率显著增加约 50%，而尿失禁的几率增加 23%，胃肠道和呼吸道并发症的几率增加超过 15%（P < 0.001）。此外，高阿片类药物处方与住院时间（LOS）和费用的显著增加相关，分别增加 12%和 6%（P < 0.001）。高阿片类药物剂量与脑血管并发症风险降低 25%（P = 0.004），而心肌梗死的几率保持不变。在脊柱病例中，阿片类药物处方通常更高，LOS 和费用的增加以及胃肠道和尿失禁并发症的观察效果更强。其他结果不太明显，可能是因为样本量较小。总体而言，较高的阿片类药物处方与大多数术后并发症的增加相关，血栓栓塞、感染和胃肠道并发症、成本和 LOS 的观察效果最强。并发症风险的增加呈阶梯式，表明存在剂量反应梯度。
