Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, California.
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri.
JAMA Facial Plast Surg. 2019 Jul 1;21(4):286-291. doi: 10.1001/jamafacial.2018.2035.
Although the development of persistent opioid use after surgical procedures has garnered much attention in recent years, large-scale studies characterizing patterns of persistent opioid use among patients undergoing plastic and reconstructive surgery procedures are lacking.
To assess the prevalence of immediate and long-term postoperative opioid use after plastic and reconstructive surgery procedures.
DESIGN, SETTING, AND PARTICIPANTS: In this population-based cohort study, patients who underwent 5 classes of plastic and reconstructive procedures (nasal, eye, breast, abdomen, and soft tissue reconstruction) between January 1, 2007, and December 31, 2015, were identified using IBM MarketScan Commercial and Medicare Supplemental research databases. Patients were excluded if they were younger than 18 years, lacked continuous insurance coverage for 1 year preoperatively and postoperatively, had a second anesthesia event within 1 year postoperatively, and filled an opioid prescription within the year prior to surgery.
Analgesic prescription patterns in the immediate postoperative period. The primary outcome was rates of persistent opioid use (opioid prescriptions filled 90-180 days postoperatively). The secondary outcome was rates of prolonged opioid use (opioid prescriptions filled 90-180 days postoperatively and again 181-365 days postoperatively). Explanatory variables included patient demographics, procedure type, and relevant comorbidities.
Of the 466 677 patients who met inclusion criteria, 96 397 (45.3%) were men, and the mean (SD) age was 46.8 (17.7) years. Furthermore, 212 387 (54.6%) of the patients filled prescriptions for postoperative analgesics, with 212 387 (91.5%) of analgesic prescriptions filled being for opioids. Persistent opioid use occurred in 30 865 (6.6%) patients (5.1%-13.5% across procedure classes), while prolonged opioid use occurred in 10 487 (2.3%) patients (1.7%-5.6% across procedure classes). Patients who filled prescriptions for opioids in the perioperative period were significantly more likely to exhibit persistent (odds ratio [OR], 2.87; 95% CI, 2.80-2.94) and prolonged (OR, 2.90; 95% CI, 2.77-3.02) opioid use than those who did not fill perioperative opioid prescriptions, with the greatest odds for persistent use found in patients who underwent breast (OR, 4.36; 95% CI, 4.10-4.63) and nasal (OR, 3.51; 95% CI, 3.30-3.73) procedures. On multivariable logistic regression analysis, independent risk factors for persistent and prolonged opioid use included perioperative opioid use, procedure type, and prior-year mental health (depression and anxiety) and substance abuse diagnoses.
Given the significant risk of persistent opioid use after plastic and reconstructive procedures, it is imperative to develop best practices guidelines for postoperative opioid prescription practices in this population.
NA.
尽管近年来手术术后持续性阿片类药物使用的发展引起了广泛关注，但缺乏大规模研究来描述整形和重建手术患者中持续性阿片类药物使用的模式。
评估整形和重建手术后即刻和长期使用阿片类药物的情况。
设计、设置和参与者：在这项基于人群的队列研究中，使用 IBM MarketScan 商业和医疗保险补充研究数据库，确定了 2007 年 1 月 1 日至 2015 年 12 月 31 日期间接受 5 类整形和重建手术（鼻、眼、乳房、腹部和软组织重建）的患者。如果患者年龄小于 18 岁、术前和术后连续保险覆盖时间不足 1 年、术后 1 年内有第二次麻醉事件以及在手术前 1 年内开了阿片类药物处方，则将其排除在外。
术后即刻镇痛处方模式。主要结局是持续性阿片类药物使用的发生率（术后 90-180 天开具的阿片类药物处方）。次要结局是延长性阿片类药物使用的发生率（术后 90-180 天和术后 181-365 天开具的阿片类药物处方）。解释变量包括患者人口统计学特征、手术类型和相关合并症。
在符合纳入标准的 466677 名患者中，96397 名（45.3%）为男性，平均（SD）年龄为 46.8（17.7）岁。此外，212387 名（54.6%）患者开具了术后镇痛药物处方，其中 212387 名（91.5%）开具的镇痛药处方为阿片类药物。30865 名（6.6%）患者发生持续性阿片类药物使用（各手术类别发生率为 5.1%-13.5%），10487 名（2.3%）患者发生延长性阿片类药物使用（各手术类别发生率为 1.7%-5.6%）。在围手术期开具阿片类药物处方的患者明显更有可能表现出持续性（比值比[OR]，2.87；95%CI，2.80-2.94）和延长性（OR，2.90；95%CI，2.77-3.02）阿片类药物使用，而在围手术期未开具阿片类药物处方的患者则不太可能发生持续性和延长性阿片类药物使用，在接受乳房（OR，4.36；95%CI，4.10-4.63）和鼻部（OR，3.51；95%CI，3.30-3.73）手术的患者中，发现持续性使用的可能性最大。多变量逻辑回归分析显示，持续性和延长性阿片类药物使用的独立风险因素包括围手术期阿片类药物使用、手术类型以及前一年的心理健康（抑郁和焦虑）和药物滥用诊断。
鉴于整形和重建手术后持续性阿片类药物使用的风险显著，因此迫切需要为该人群制定术后阿片类药物处方实践的最佳实践指南。
无。
