Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Surg Res. 2019 Jun;238:29-34. doi: 10.1016/j.jss.2019.01.016. Epub 2019 Feb 5.
Prior opioid use has been shown to be associated with adverse outcomes in surgical and trauma patients. We sought to evaluate the influence of prior opioid use on prescription opioid requirements after orthopedic trauma.
This was a retrospective review of TRICARE claims (2006-2014). We evaluated the records of 11,752 patients treated for orthopedic injuries. Surveillance for prior opioid exposure extended to 6 mo before the traumatic event, with similar postinjury surveillance. Preinjury opioid use was categorized as unexposed, exposed without sustained use (nonsustained users), and sustained use (6 mo or longer of continuous opioid prescriptions without interruption). Multivariable Cox proportional hazard models were used to adjust for confounding and determine factors independently associated with the discontinuation of prescription opioid use after traumatic injury.
Prior opioid exposure among nonsustained users (hazard ratio 0.78; 95% CI 0.74, 0.83) and sustained use at the time of injury (hazard ratio 0.40; 95% CI: 0.35, 0.47) were associated with lower likelihoods of opioid discontinuation. Additional factors associated with lower likelihoods of opioid discontinuation included our proxy for lower socioeconomic status, history of depression or anxiety, injury severity, and intensive care unit admission.
Prior opioid use is one of the strongest predictors of continued use following treatment, along with socioeconomic status, behavioral health disorders, and severity of injury. Appropriate discharge planning and early engagement of ancillary services in individuals with one or more of the risk factors identified here may reduce the likelihood of sustained opioid use after injury.
先前的阿片类药物使用已被证明与手术和创伤患者的不良结局相关。我们试图评估先前的阿片类药物使用对骨科创伤后处方阿片类药物需求的影响。
这是一项对 TRICARE 索赔的回顾性研究（2006-2014 年）。我们评估了 11752 名接受骨科损伤治疗的患者的记录。先前阿片类药物暴露的监测延伸到创伤事件前 6 个月，类似的伤后监测。受伤前阿片类药物使用分为未暴露、无持续使用（非持续使用者）和持续使用（6 个月或更长时间的连续阿片类药物处方且无中断）。多变量 Cox 比例风险模型用于调整混杂因素，并确定与创伤后停止处方阿片类药物使用相关的独立因素。
非持续使用者的先前阿片类药物暴露（风险比 0.78；95%置信区间 0.74，0.83）和受伤时的持续使用（风险比 0.40；95%置信区间：0.35，0.47）与较低的阿片类药物停药可能性相关。与较低的阿片类药物停药可能性相关的其他因素包括我们的社会经济地位较低的代理、抑郁或焦虑史、损伤严重程度和重症监护病房入院。
先前的阿片类药物使用是治疗后继续使用的最强预测因素之一，与社会经济地位、行为健康障碍和损伤严重程度有关。在识别出有一个或多个风险因素的个体中，适当的出院计划和早期参与辅助服务可能会降低受伤后持续使用阿片类药物的可能性。
