Pitter Frederik Taylor, Sikora Matt, Lindberg-Larsen Martin, Pedersen Alma Becic, Dahl Benny, Gehrchen Martin
Spine Unit, Department of Orthopedic Surgery, University Hospital of Copenhagen Rigshospitalet, Copenhagen, Denmark.
Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA, USA.
Neurospine. 2020 Mar;17(1):237-245. doi: 10.14245/ns.1938106.053. Epub 2019 Jul 24.
To report the 1-year pre and postoperative analgesic use in patients undergoing primary surgery for adult spinal deformity (ASD) and assess risk factors for chronic postoperative opioid use.
Patients > 18 years undergoing primary instrumented surgery for ASD in Denmark between 2006 and 2016 were identified in the Danish National Patient Registry. Information on analgesic use were obtained from the Danish National Health Service Prescription Database. Use of analgesics was calculated one year before and after surgery for each patient, per quarter (-Q4 to -Q1 before and Q1 to Q4 after). Users were defined as patient with one or more prescriptions in the given quarter.
We identified 892 patients. Preoperatively, 28% (n = 246) of patients were opioid users in -Q4 and 33% (n = 295) in -Q1. Postoperatively, 85% (n = 756) of patients were opioid users in Q1 and 31% (n = 280) in Q4. Proportions of users of other analgesics (paracetamol, antidepressants, and anticonvulsants) were stable before and after surgery. Use of nonsteroidal anti-inflammatory drug decreased postoperatively by 40% (-Q1 vs. Q4). 26% of patients had chronic preoperative opioid use (one or more prescriptions in each -Q2 and -Q1) and 24% had chronic postoperative use (prescription each of Q1-Q4). Multivariate logistic regression analysis showed age increment per 10 years and preoperative chronic opioid use as risk factors for chronic postoperative opioid use.
One year after ASD surgery, opioid use was not reduced compared to preoperative usage.
报告接受成人脊柱畸形（ASD）初次手术患者术前及术后1年的镇痛药物使用情况，并评估术后长期使用阿片类药物的风险因素。
在丹麦国家患者登记处中识别出2006年至2016年间在丹麦接受ASD初次器械手术且年龄大于18岁的患者。镇痛药物使用信息来自丹麦国家卫生服务处方数据库。计算每位患者手术前和手术后一年每季度（术前第4季度至第1季度，术后第1季度至第4季度）的镇痛药物使用情况。使用者定义为在给定季度有一张或多张处方的患者。
我们识别出892例患者。术前，第4季度28%（n = 246）的患者为阿片类药物使用者，第1季度为33%（n = 295）。术后，第1季度85%（n = 756）的患者为阿片类药物使用者，第4季度为31%（n = 280）。其他镇痛药物（对乙酰氨基酚、抗抑郁药和抗惊厥药）使用者的比例在手术前后保持稳定。非甾体抗炎药的使用术后下降了40%（术前第1季度与术后第4季度相比）。26%的患者术前长期使用阿片类药物（第2季度和第1季度各有一张或多张处方），24%的患者术后长期使用（第1季度至第4季度各有处方）。多因素逻辑回归分析显示，每增加10岁的年龄增长以及术前长期使用阿片类药物是术后长期使用阿片类药物的风险因素。
ASD手术后1年，与术前使用情况相比，阿片类药物的使用并未减少。
