Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Ann Surg. 2021 Apr 1;273(4):743-750. doi: 10.1097/SLA.0000000000003549.
The aim of this study was to evaluate differences in risk of long-term opioid therapy after surgery among an opioid-naive population using varying cutoffs based on days supplied (DS), total morphine milligram equivalents (MME) dispensed, and quantity of pills (QTY) dispensed.
In response to the US opioid crisis, opioid prescription (Rx) limits have been implemented on a state-by-state basis beginning in 2016. However, there is limited evidence informing appropriate prescribing limits, and the effect of these policies on long-term opioid therapy.
Using the MarketScan claims databases, we identified all opioid-naive patients undergoing outpatient surgery between July 1, 2006 and June 30, 2015. We identified the initial postsurgical opioid prescribed, examining the DS, total MME, and QTY dispensed. We used Poisson to estimate adjusted risk differences and risk ratios of long-term opioid use comparing those receiving larger versus smaller volume of opioids.
We identified 5,148,485 opioid-naive surgical patients. Overall, 55.5% received an opioid for postoperative pain, with median days supply = 5 and median total MME = 240. The proportion of patients receiving prescriptions above 7 DS increased from 11% in 2006 to 19% in 2015. Among those receiving postoperative opioids, 8% had long-term opioid use, and risk of long-term use was 1.16 times [95% confidence interval (CI), 1.10-1.25] higher among those receiving >7 days compared with those receiving ≤7 days. Those receiving >400 total MME (15% of patients) were at 1.17 times (95% CI, 1.10-1.25) the risk of long-term use compared with those receiving ≤400 MME.
Between 2005 and 2015, the amounts of opioids prescribed for postoperative pain increased dramatically, and receipt of larger volume of opioids was associated with increased risk of long-term opioid therapy.
本研究旨在评估在一个阿片类药物初治人群中，使用不同基于供应量（DS）、总吗啡毫克当量（MME）和配药量（QTY）的截止值，手术患者长期使用阿片类药物的风险差异。
为应对美国阿片类药物危机，自 2016 年以来，各州已开始实施阿片类药物处方限制。然而，目前尚无充分证据表明适当的处方限制，且这些政策对长期阿片类药物治疗的影响也知之甚少。
我们使用 MarketScan 索赔数据库，确定了 2006 年 7 月 1 日至 2015 年 6 月 30 日期间接受门诊手术的所有阿片类药物初治患者。我们确定了初始术后开具的阿片类药物，检查了供应量、总 MME 和配药量。我们使用泊松分布来估计长期使用阿片类药物的调整风险差异和风险比，比较接受较大或较小阿片类药物量的患者。
我们确定了 5148485 名阿片类药物初治手术患者。总体而言，55.5%的患者接受了术后疼痛的阿片类药物治疗，中位数供应量为 5 天，中位数总 MME 为 240。接受 7 天以上供应量处方的患者比例从 2006 年的 11%增加到 2015 年的 19%。在接受术后阿片类药物治疗的患者中，有 8%的患者存在长期阿片类药物使用，与接受 7 天以下供应量相比，接受 >7 天供应量的患者长期使用的风险高 1.16 倍（95%置信区间，1.10-1.25）。接受 >400 总 MME（占患者的 15%）的患者，与接受 ≤400 MME 的患者相比，长期使用阿片类药物的风险高 1.17 倍（95%置信区间，1.10-1.25）。
在 2005 年至 2015 年间，用于术后疼痛的阿片类药物处方量大幅增加，接受较大剂量的阿片类药物与长期使用阿片类药物的风险增加相关。
