Department of Surgery, University of Michigan, Ann Arbor, MI.
Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI.
Ann Surg. 2020 Jun;271(6):1080-1086. doi: 10.1097/SLA.0000000000003109.
We characterized patterns of preoperative opioid use in patients undergoing elective surgery to identify the relationship between preoperative use and subsequent opioid fill after surgery.
Preoperative opioid use is common, and varies by dose, recency, duration, and continuity of fills. To date, there is little evidence to guide postoperative prescribing need based on prior opioid use.
We analyzed claims data from Clinformatics DataMart Database for patients aged 18 to 64 years undergoing major and minor surgery between 2008 and 2015. Preoperative use was defined as any opioid prescription filled in the year before surgery. We used cluster analysis to group patients by the dose, recency, duration, and continuity of use. Our primary outcome was second postoperative fill within 30 postoperative days. Our primary explanatory variable was opioid use group. We used logistic regression to examine likelihood of second fill by opioid use group.
Out of 267,252 patients, 102,748 (38%) filled an opioid prescription in the 12 months before surgery. Cluster analysis yielded 6 groups of preoperative opioid use, ranging from minimal (27.6%) to intermittent (7.7%) to chronic use (2.7%). Preoperative opioid use was the most influential predictor of second fill, with larger effect sizes than other factors even for patients with minimal or intermittent opioid use. Increasing preoperative use was associated with risk-adjusted likelihood of requiring a second opioid fill compared with naive patients [minimal use: odds ratio (OR) 1.49, 95% confidence interval (95% CI) 1.45-1.53; recent intermittent use: OR 6.51, 95% CI 6.16-6.88; high chronic use: OR 60.79, 95% CI 27.81-132.92, all P values <0.001).
Preoperative opioid use is common among patients who undergo elective surgery. Although the majority of patients infrequently fill opioids before surgery, even minimal use increases the probability of needing additional postoperative prescriptions in the 30 days after surgery when compared with opioid-naive patients. Going forward, identifying preoperative opioid use can inform surgeon prescribing and care coordination for pain management after surgery.
本研究通过分析择期手术患者术前阿片类药物使用模式，明确术前使用阿片类药物与术后阿片类药物续开之间的关系。
术前使用阿片类药物较为常见，其使用剂量、频率、时长和连续性存在差异。目前，尚无明确的循证医学证据来指导基于患者术前阿片类药物使用情况的术后处方开具。
我们分析了 2008 年至 2015 年期间在 Clinformatics DataMart 数据库中接受大、小手术的年龄在 18 至 64 岁的患者的理赔数据。术前使用定义为术前 1 年内开具的任何阿片类药物处方。我们使用聚类分析将患者分为剂量、频率、时长和使用连续性不同的用药组。我们的主要结局是术后 30 天内第二次术后开方。我们的主要解释变量是阿片类药物使用组。我们使用逻辑回归检验不同阿片类药物使用组患者第二次开方的可能性。
在 267252 名患者中，102748 名（38%）在术前 12 个月内开具了阿片类药物处方。聚类分析得到了 6 种术前阿片类药物使用模式，从最小（27.6%）到间歇性（7.7%）再到慢性使用（2.7%）。术前阿片类药物使用是第二次开方的最主要影响因素，即使对于使用最小剂量或间歇性使用阿片类药物的患者，其效应大小也大于其他因素。与初次使用阿片类药物的患者相比，术前阿片类药物使用量增加与需要第二次开阿片类药物处方的风险调整可能性相关[最小使用量：比值比（OR）1.49，95%置信区间（95%CI）1.45-1.53；近期间歇性使用：OR 6.51，95%CI 6.16-6.88；高慢性使用：OR 60.79，95%CI 27.81-132.92，所有 P 值均<0.001]。
择期手术患者术前使用阿片类药物较为常见。尽管大多数患者术前阿片类药物使用频率较低，但与初次使用阿片类药物的患者相比，即使是最小剂量的使用也会增加术后 30 天内需要额外开具阿片类药物处方的可能性。未来，确定患者术前是否使用过阿片类药物可以为术后疼痛管理的外科医生开具处方和提供护理协调提供参考。
