From the Department of Orthopaedic Surgery, Northwestern University, Chicago, IL.
J Am Acad Orthop Surg. 2019 Jan 1;27(1):32-38. doi: 10.5435/JAAOS-D-17-00304.
Opioid abuse and dependence have a detrimental effect on elective orthopaedic surgeries, yet pain control is an important predictor of postoperative satisfaction. We aimed at better defining risk factors for prolonged postoperative opioid requirements and risk factors for patients requiring higher doses of opioids after spine surgery.
The Illinois Prescription Monitoring Program was queried to analyze opioid dispensation patterns at 3 and 6 months postoperatively for adult patients who had spine surgery at a tertiary care hospital by a single surgeon over a 5-year period. Patients were divided into three groups: group 1 patients had opioid dispensed to them 3 and 6 months preoperatively, group 2 patients had opioid dispensed to them only at 3 months preoperatively, and group 3 patients did not have preoperative opioid prescriptions. Demographic characteristics, psychiatric history, smoking status, alcohol use, body mass index, surgical region, and presence of multiple prescribers were abstracted. Statistical analysis included multivariate modified Poisson regression, linear regression, and chi-squared testing when appropriate.
Patients in group 1 were at significantly increased risk of continued opioid usage than those in group 2 (relative risk, 3.934; 95% confidence interval, 1.691 to 9.150; P = 0.0015) and those in group 3 (relative risk, 4.004; 95% confidence interval, 1.712 to 9.365; P = 0.0014) at 6 months postoperatively. Group 1 patients also had larger quantities of opioid dispensed to them relative to patients in group 2 or group 3 (P < 0.0001) at 6 months postoperatively.
Use of opioid medications at 6 months preoperatively is a risk factor for continued usage and at higher doses 6 months postoperatively.
Level III: retrospective cohort study.
阿片类药物滥用和依赖对择期矫形外科手术有不利影响，但疼痛控制是术后满意度的重要预测因素。我们旨在更好地定义术后阿片类药物需求延长的危险因素，以及脊柱手术后需要更高剂量阿片类药物的患者的危险因素。
通过对一名外科医生在 5 年内对一家三级护理医院进行脊柱手术的成年患者的术后 3 个月和 6 个月的阿片类药物配药模式进行分析，查询伊利诺伊州处方监测计划。患者分为三组：组 1 患者在术前 3 个月和 6 个月有阿片类药物配药，组 2 患者仅在术前 3 个月有阿片类药物配药，组 3 患者没有术前阿片类药物处方。提取人口统计学特征、精神病史、吸烟状况、饮酒状况、体重指数、手术部位和多个处方医生的存在情况。适当的时候进行了多变量修正泊松回归、线性回归和卡方检验。
与组 2（相对风险，3.934；95%置信区间，1.691 至 9.150；P = 0.0015）和组 3（相对风险，4.004；95%置信区间，1.712 至 9.365；P = 0.0014）相比，组 1 患者在术后 6 个月时继续使用阿片类药物的风险显著增加。与组 2 或组 3 相比，组 1 患者在术后 6 个月时也开具了更多的阿片类药物（P < 0.0001）。
术前 6 个月使用阿片类药物是术后 6 个月继续使用和更高剂量的危险因素。
三级：回顾性队列研究。
