术前阿片类药物与脊柱手术后 1 年患者报告结局。
Preoperative Opioids and 1-year Patient-reported Outcomes After Spine Surgery.
机构信息
Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN.
Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN.
出版信息
Spine (Phila Pa 1976). 2019 Jun 15;44(12):887-895. doi: 10.1097/BRS.0000000000002964.
STUDY DESIGN
Longitudinal Cohort Study.
OBJECTIVE
Determine 1-year patient-reported outcomes associated with preoperative chronic opioid therapy and high-preoperative opioid dosages in patients undergoing elective spine surgery.
SUMMARY OF BACKGROUND DATA
Back pain is the most disabling condition worldwide and over half of patients presenting for spine surgery report using opioids. Preoperative dosage has been correlated with poor outcomes, but published studies have not assessed the relationship of both preoperative chronic opioids and opioid dosage with patient-reported outcomes.
METHODS
For patients undergoing elective spine surgery between 2010 and 2017, our prospective institutional spine registry data was linked to opioid prescription data collected from our state's Prescription Drug Monitoring Program to analyze outcomes associated with preoperative chronic opioid therapy and high-preoperative opioid dosage, while adjusting for confounders through multivariable regression analyses. Outcomes included 1-year meaningful improvements in pain, function, and quality of life. Additional outcomes included 1-year satisfaction, return to work, 90-day complications, and postoperative chronic opioid use.
RESULTS
Of 2128 patients included, preoperative chronic opioid therapy was identified in 21% and was associated with significantly higher odds (adjusted odds ratio [95% confidence interval]) of not achieving meaningful improvements at 1-year in extremity pain (aOR:1.5 [1.2-2]), axial pain (aOR:1.7 [1.4-2.2]), function (aOR:1.7 [1.4-2.2]), and quality of life (aOR:1.4 [1.2-1.9]); dissatisfaction (aOR:1.7 [1.3-2.2]); 90-day complications (aOR:2.9 [1.7-4.9]); and postoperative chronic opioid use (aOR:15 [11.4-19.7]). High-preoperative opioid dosage was only associated with postoperative chronic opioid use (aOR:4.9 [3-7.9]).
CONCLUSION
Patients treated with chronic opioids prior to spine surgery are significantly less likely to achieve meaningful improvements at 1-year in pain, function, and quality of life; and less likely to be satisfied at 1-year with higher odds of 90-day complications, regardless of dosage. Both preoperative chronic opioid therapy and high-preoperative dosage are independently associated with postoperative chronic opioid use.
LEVEL OF EVIDENCE
研究设计
纵向队列研究。
目的
确定在接受择期脊柱手术的患者中，与术前慢性阿片类药物治疗和高术前阿片类药物剂量相关的 1 年患者报告结果。
背景数据概要
背痛是全球最致残的疾病，超过一半接受脊柱手术的患者报告使用阿片类药物。术前剂量与不良结果相关，但已发表的研究并未评估术前慢性阿片类药物和阿片类药物剂量与患者报告结果的关系。
方法
对于 2010 年至 2017 年期间接受择期脊柱手术的患者，我们将前瞻性机构脊柱登记处的数据与从我们州的处方药物监测计划中收集的阿片类药物处方数据相关联，以分析与术前慢性阿片类药物治疗和高术前阿片类药物剂量相关的结果，同时通过多变量回归分析调整混杂因素。结果包括疼痛、功能和生活质量在 1 年内有明显改善。其他结果包括 1 年满意度、重返工作岗位、90 天并发症和术后慢性阿片类药物使用。
结果
在纳入的 2128 名患者中，术前慢性阿片类药物治疗的发生率为 21%，并且与在 1 年内肢体疼痛（调整后的优势比[95%置信区间]）、轴向疼痛（调整后的优势比[95%置信区间]）、功能（调整后的优势比[95%置信区间]）和生活质量（调整后的优势比[95%置信区间]）无明显改善的可能性显著更高；不满意（调整后的优势比[95%置信区间]）；90 天并发症（调整后的优势比[95%置信区间]）；和术后慢性阿片类药物使用（调整后的优势比[95%置信区间]）显著更高。高术前阿片类药物剂量仅与术后慢性阿片类药物使用相关（调整后的优势比[95%置信区间]）。
结论
在脊柱手术前接受慢性阿片类药物治疗的患者在 1 年内疼痛、功能和生活质量方面取得明显改善的可能性显著降低；并且在 90 天内发生并发症的可能性更高，无论剂量如何，对术后慢性阿片类药物使用的满意度也较低。术前慢性阿片类药物治疗和高术前剂量均与术后慢性阿片类药物使用独立相关。
证据水平
2。
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