阿片类药物-naive 住院患者的阿片类药物给药模式及其与出院后阿片类药物使用的关联：一项队列研究。
Patterns of Opioid Administration Among Opioid-Naive Inpatients and Associations With Postdischarge Opioid Use: A Cohort Study.
机构信息
University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania (J.M.D.).
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (J.N.K., C.W.S., T.D.G., O.C.M., D.C.A.).
出版信息
Ann Intern Med. 2019 Jul 16;171(2):81-90. doi: 10.7326/M18-2864. Epub 2019 Jun 18.
BACKGROUND
Patterns of inpatient opioid use and their associations with postdischarge opioid use are poorly understood.
OBJECTIVE
To measure patterns in timing, duration, and setting of opioid administration in opioid-naive hospitalized patients and to examine associations with postdischarge use.
DESIGN
Retrospective cohort study using electronic health record data from 2010 to 2014.
SETTING
12 community and academic hospitals in Pennsylvania.
PATIENTS
148 068 opioid-naive patients (191 249 admissions) with at least 1 outpatient encounter within 12 months before and after admission.
MEASUREMENTS
Number of days and patterns of inpatient opioid use; any outpatient use (self-report and/or prescription orders) 90 and 365 days after discharge.
RESULTS
Opioids were administered in 48% of admissions. Patients were given opioids for a mean of 67.9% (SD, 25.0%) of their stay. Location of administration of first opioid on admission, timing of last opioid before discharge, and receipt of nonopioid analgesics varied substantially. After adjustment for potential confounders, 5.9% of inpatients receiving opioids had outpatient use at 90 days compared with 3.0% of those without inpatient use (difference, 3.0 percentage points [95% CI, 2.8 to 3.2 percentage points]). Opioid use at 90 days was higher in inpatients receiving opioids less than 12 hours before discharge than in those with at least 24 opioid-free hours before discharge (7.5% vs. 3.9%; difference, 3.6 percentage points [CI, 3.3 to 3.9 percentage points]). Differences based on proportion of the stay with opioid use were modest (opioid use at 90 days was 6.4% and 5.4%, respectively, for patients with opioid use for ≥75% vs. ≤25% of their stay; difference, 1.0 percentage point [CI, 0.4 to 1.5 percentage points]). Associations were similar for opioid use 365 days after discharge.
LIMITATION
Potential unmeasured confounders related to opioid use.
CONCLUSION
This study found high rates of opioid administration to opioid-naive inpatients and associations between specific patterns of inpatient use and risk for long-term use after discharge.
PRIMARY FUNDING SOURCE
UPMC Health System and University of Pittsburgh.
背景
住院患者阿片类药物使用模式及其与出院后阿片类药物使用的关系尚不清楚。
目的
测量阿片类药物初治住院患者的阿片类药物给药时间、持续时间和给药地点的模式，并探讨其与出院后使用的关系。
设计
回顾性队列研究，使用 2010 年至 2014 年的电子健康记录数据。
地点
宾夕法尼亚州的 12 家社区和学术医院。
患者
148068 名阿片类药物初治患者（191249 人次住院），在入院前和入院后 12 个月内至少有 1 次门诊就诊。
测量方法
住院期间阿片类药物使用的天数和模式；出院后 90 和 365 天的任何门诊使用（自我报告和/或处方医嘱）。
结果
48%的住院患者接受了阿片类药物治疗。患者接受阿片类药物治疗的平均时间为住院时间的 67.9%（标准差，25.0%）。入院时首次给予阿片类药物的地点、出院前最后一次给予阿片类药物的时间以及非阿片类镇痛药的使用情况差异很大。在调整了潜在混杂因素后，5.9%接受阿片类药物治疗的住院患者在 90 天时出现门诊使用，而未接受阿片类药物治疗的患者为 3.0%（差异为 3.0 个百分点[95%置信区间，2.8 至 3.2 个百分点]）。与至少 24 小时无阿片类药物治疗的患者相比，在出院前 12 小时内接受阿片类药物治疗的患者在 90 天时使用阿片类药物的比例更高（7.5% vs. 3.9%；差异为 3.6 个百分点[95%置信区间，3.3 至 3.9 个百分点]）。基于阿片类药物使用时间比例的差异较小（使用阿片类药物≥75%与≤25%的患者在 90 天时使用阿片类药物的比例分别为 6.4%和 5.4%；差异为 1.0 个百分点[95%置信区间，0.4 至 1.5 个百分点]）。出院后 365 天使用阿片类药物的情况也类似。
局限性
与阿片类药物使用相关的潜在未测量混杂因素。
结论
本研究发现，阿片类药物初治住院患者接受阿片类药物治疗的比例较高，且阿片类药物的具体使用模式与出院后长期使用的风险之间存在关联。
主要资金来源
UPMC 医疗系统和匹兹堡大学。
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