Quality Use of Medicines and Pharmacy Research Centre, University of South Australia Division of Health Sciences, Adelaide, South Australia, Australia.
BMJ Open. 2019 Apr 16;9(4):e023990. doi: 10.1136/bmjopen-2018-023990.
To determine time to opioid cessation post discharge from hospital in persons who had been admitted to hospital for a surgical procedure and were previously naïve to opioids.
DESIGN, SETTING AND PARTICIPANTS: Retrospective cohort study using administrative health claims database from the Australian Government Department of Veterans' Affairs (DVA). DVA gold card holders aged between 18 and 100 years who were admitted to hospital for a surgical admission between 1 January 2014 and 30 December 2015 and naïve to opioid therapy prior to admission were included in the study. Gold card holders are eligible for all health services that DVA funds.
The outcome of interest was time to cessation of opioids, with follow-up occurring over 12 months. Cessation was defined as a period without an opioid prescription that was equivalent to three times the estimated supply duration. The proportion who became chronic opioid users was defined as those who continued taking opioids for greater than 90 days post discharge. Cumulative incidence function with death as a competing event was used to determine time to cessation of opioids post discharge.
In 2014-2015, 24 854 persons were admitted for a surgical admission. In total 3907 (15.7%) were discharged on opioids. In total 3.9% of those discharged on opioids became chronic users of opioids. The opioid that the patients were most frequently discharged with was oxycodone; oxycodone alone accounted for 43%, while oxycodone with naloxone accounted for 8%.
Opioid initiation post-surgical hospital admission leads to chronic use of opioids in a small percentage of the population. However, given the frequency at which surgical procedures occur, this means that a large number of people in the population may be affected. Post-discharge assessment and follow-up of at-risk patients is important, particularly where psychosocial elements such as anxiety and catastrophising are identified.
确定在因手术住院且之前未使用过阿片类药物的人群中，出院后停止使用阿片类药物的时间。
设计、地点和参与者：这是一项使用澳大利亚退伍军人事务部（DVA）行政健康索赔数据库的回顾性队列研究。研究纳入了 2014 年 1 月 1 日至 2015 年 12 月 30 日期间因手术住院且入院前未接受过阿片类药物治疗的年龄在 18 至 100 岁之间的 DVA 金卡持有者。金卡持有者有资格享受 DVA 资助的所有医疗服务。
感兴趣的结局是停止使用阿片类药物的时间，随访时间为 12 个月。停止使用定义为没有阿片类药物处方的时期，相当于估计供应时间的三倍。将成为慢性阿片类药物使用者的比例定义为那些在出院后继续服用阿片类药物超过 90 天的患者。使用累积发生率函数并以死亡为竞争事件来确定出院后停止使用阿片类药物的时间。
2014-2015 年，有 24854 人因手术住院。共有 3907 人（15.7%）出院时使用阿片类药物。出院时使用阿片类药物的患者中，有 3.9%成为慢性阿片类药物使用者。患者出院时最常使用的阿片类药物是羟考酮；单独使用羟考酮的占 43%，而羟考酮与纳洛酮合用的占 8%。
手术后住院患者开始使用阿片类药物后，会导致一小部分人群慢性使用阿片类药物。然而，鉴于手术的频率，这意味着很多人可能会受到影响。对有风险的患者进行出院后评估和随访非常重要，特别是在确定存在焦虑和灾难化等心理社会因素时。
