Departments of Thoracic and Cardiovascular Surgery.
Anesthesiology and Perioperative Medicine.
Pain. 2019 Oct;160(10):2365-2373. doi: 10.1097/j.pain.0000000000001630.
The incidence of persistent opioid use after lung surgery is high. Although adverse effects by opioids have been well described, it is unknown whether persistent opioid use is associated with worse survival. Patients who received a lobectomy for stage I NSCLC from 2007 to 2013 were identified from the Surveillance, Epidemiology and End Results-Medicare database. Opioid use was ascertained through records of prescriptions filled through part D. Patients were matched 2:1 according to their likelihood of persistent opioid use, which was defined as any opioid prescription filled 3 to 6 months after surgery. Two thousand eight hundred eighty-four patients were identified. The incidence of persistent opioid use 3 to 6 months after surgery was 27.0%. After matching, persistent opioid use was associated with worse overall survival (P < 0.001) and cancer-specific survival (P < 0.001). Those who used the lowest quartile of opioids, which was often manifested as a single opioid prescription, showed similar overall survival as no opioid use (HR 1.27, 95% confidence interval [CI] 0.93-1.72). However, the second and third quartiles of opioid use were associated with decreased overall survival (HR 1.53, 95% CI 1.14-2.03 and HR 1.39, 95% CI 1.04-1.86, respectively) that was nonetheless less severe than the highest quartile of opioid use (HR 2.50, 95% CI 1.95-3.21). Age, sex, marital status, comorbidity, tumor size, tumor grade, and radiation were also associated with worse overall survival, with chemotherapy use and video-assisted thoracoscopic surgery being associated with improved overall survival. Persistent opioid use 3 to 6 months after lobectomy is independently associated with worse overall survival and worse cancer-specific survival.
肺手术后持续使用阿片类药物的发生率很高。尽管阿片类药物的不良反应已得到充分描述，但尚不清楚持续使用阿片类药物是否与生存预后更差相关。从监测、流行病学和最终结果-医疗保险数据库中确定了 2007 年至 2013 年间接受 I 期非小细胞肺癌肺叶切除术的患者。通过部分 D 部分填写的处方记录确定阿片类药物的使用情况。根据他们持续使用阿片类药物的可能性，对患者进行了 2:1 匹配，这是指术后 3 至 6 个月内任何阿片类药物处方。共确定了 2884 例患者。术后 3 至 6 个月持续使用阿片类药物的发生率为 27.0%。匹配后，持续使用阿片类药物与总生存（P < 0.001）和癌症特异性生存（P < 0.001）更差相关。那些使用最低四分位数的阿片类药物的患者，通常表现为单一阿片类药物处方，与不使用阿片类药物的患者的总生存相似（HR 1.27，95%置信区间 [CI] 0.93-1.72）。然而，第二和第三四分位数的阿片类药物使用与总生存降低相关（HR 1.53，95%CI 1.14-2.03 和 HR 1.39，95%CI 1.04-1.86），但不及最高四分位数的阿片类药物使用严重（HR 2.50，95%CI 1.95-3.21）。年龄、性别、婚姻状况、合并症、肿瘤大小、肿瘤分级和放疗也与总生存更差相关，化疗和电视辅助胸腔镜手术与总生存改善相关。肺叶切除术后 3 至 6 个月持续使用阿片类药物与总生存和癌症特异性生存更差独立相关。
