Stark N, Kerr S, Stevens J
Anaesth Intensive Care. 2017 Nov;45(6):700-706. doi: 10.1177/0310057X1704500609.
Post-surgical opioid prescribing intended for the short-term management of acute pain may lead to long-term opioid use. This study was undertaken to determine the prevalence of persistent post-surgical opioid use and patient-related factors associated with post-surgical opioid use. One thousand and thirteen opioid-naïve patients awaiting elective surgery in a tertiary private hospital in Sydney were enrolled. Preoperatively, patients completed a questionnaire comprising potential predictors of persistent post-surgical opioid use. Patients underwent surgery with routine perioperative care, and were followed up at 90 to 120 days after surgery to determine opioid use. Factors associated with opioid use were assessed with logistic regression. We had an overall response rate of 95.8% (n=970) of patients, of whom 10.5% (n=102) continued to use opioids at >90 days after surgery. On surgical subtype analysis, the prevalence of persistent opioid use was 23.6% after spinal surgery, and 13.7% after orthopaedic surgery. Four factors were independently associated with persistent post-surgical opioid use in a multivariate model: having orthopaedic (odds ratio [OR] 4.6, 95% confidence interval [CI] 2.0 to 10.8, <0.001) or spinal surgery (OR 4.0, 95% CI 1.7 to 9.2, <0.001), anxiety (OR 2.1, 95% CI 1.1 to 4.1, =0.03), attending pre-admission clinic (OR 3.7, 95% CI 1.6 to 8.6, =0.002), and higher self-reported pain score at >90 days after surgery ( <0.001). More than 10% of opioid-naïve patients undergoing elective surgery experience persistent post-surgical opioid use. Identification of factors associated with persistent post-surgical opioid use may allow development of a risk stratification tool to predict those at highest risk.
用于急性疼痛短期管理的术后阿片类药物处方可能会导致长期使用阿片类药物。本研究旨在确定术后持续使用阿片类药物的患病率以及与术后阿片类药物使用相关的患者因素。悉尼一家三级私立医院的1013名未使用过阿片类药物且等待择期手术的患者被纳入研究。术前，患者完成了一份包含术后持续使用阿片类药物潜在预测因素的问卷。患者接受常规围手术期护理进行手术，并在术后90至120天进行随访以确定阿片类药物的使用情况。使用逻辑回归评估与阿片类药物使用相关的因素。我们的患者总体应答率为95.8%（n = 970），其中10.5%（n = 102）在术后90天以上继续使用阿片类药物。在手术亚型分析中，脊柱手术后持续使用阿片类药物的患病率为23.6%，骨科手术后为13.7%。在多变量模型中，有四个因素与术后持续使用阿片类药物独立相关：接受骨科（比值比[OR] 4.6，95%置信区间[CI] 2.0至10.8，<0.001）或脊柱手术（OR 4.0，95% CI 1.7至9.2，<0.001）、焦虑（OR 2.1，95% CI 1.1至4.1，= 0.03）、参加入院前门诊（OR 3.7，95% CI 1.6至8.6，= 0.002）以及术后90天以上自我报告的疼痛评分较高（<0.001）。超过10%未使用过阿片类药物的择期手术患者经历了术后持续使用阿片类药物。识别与术后持续使用阿片类药物相关的因素可能有助于开发一种风险分层工具，以预测风险最高的患者。
