Birmingham VA Medical Center, Birmingham, AL, USA; Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Veterans Affairs, Palo Alto, Veterans Affairs Medical Center, Palo Alto, CA, USA; Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, USA.
Am J Surg. 2019 Nov;218(5):828-835. doi: 10.1016/j.amjsurg.2019.02.033. Epub 2019 Feb 28.
The extent of preoperative opioid utilization and the relationship with pain-related readmissions are not well understood.
VA Surgical Quality Improvement Program data on general, vascular, and orthopedic surgeries (2007-2014) were merged with pharmacy data to evaluate preoperative opioid use and pain-related readmissions. Opioid use in the 6-month preoperative period was categorized as none, infrequent, frequent, and daily.
In the six-month preoperative period, 65.7% had no opioid use, 16.7% had infrequent use, 6.3% frequent use, and 11.4% were daily opioid users. Adjusted odds of pain-related readmission were higher for opioid-exposed groups vs the opioid-naïve group: infrequent (OR 1.17; 95% CI:1.04-1.31), frequent (OR 1.28; 95% CI:1.08-1.52), and daily (OR 1.49; 95% CI:1.27-1.74). Among preoperative opioid users, those with a pain-related readmission had higher daily preoperative oral morphine equivalents (mean 44.5 vs. 36.1, p < 0.001).
Patients using opioids preoperatively experienced higher rates of pain-related readmissions, which increased with frequency and dosage of opioid exposure.
术前阿片类药物使用的程度及其与疼痛相关再入院的关系尚不清楚。
VA 手术质量改进计划的数据（2007-2014 年）与药房数据合并，以评估术前阿片类药物的使用情况和与疼痛相关的再入院情况。术前 6 个月内的阿片类药物使用情况分为无、不频繁、频繁和每日。
在术前 6 个月内，65.7%的患者没有使用阿片类药物，16.7%的患者不频繁使用，6.3%的患者频繁使用，11.4%的患者每天使用阿片类药物。与阿片类药物未暴露组相比，阿片类药物暴露组发生疼痛相关再入院的调整后比值比更高：不频繁（OR 1.17；95%CI：1.04-1.31），频繁（OR 1.28；95%CI：1.08-1.52），和每日（OR 1.49；95%CI：1.27-1.74）。在术前使用阿片类药物的患者中，疼痛相关再入院的患者术前每日口服吗啡当量较高（平均值 44.5 比 36.1，p<0.001）。
术前使用阿片类药物的患者疼痛相关再入院率较高，且随着阿片类药物暴露的频率和剂量的增加而增加。
