Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA.
Department of Neurosurgery, Virginia Mason Medical Center, Seattle, WA.
Spine (Phila Pa 1976). 2020 Jan 1;45(1):E54-E60. doi: 10.1097/BRS.0000000000003199.
Single-institution retrospective cohort study.
To determine whether prescribing practices at discharge are associated with opioid dependence (OD) in patients undergoing discectomy or laminectomy procedures for degenerative indications.
Long-term opioid use in spine surgery is associated with higher healthcare utilization and worse postoperative outcomes. The impact of prescribing practices at discharge within this surgical population is poorly understood.
A query of an administrative database was conducted to identify all patients undergoing discectomy or laminectomy procedures at our high-volume tertiary referral center between 2007 and 2016. For patients included in the analysis, opioid prescription data on admission and discharge were manually abstracted from the electronic health record, including opioid type, frequency, route, and dose, and then converted to daily morphine equivalent dose (MED) values. We defined OD as a consecutive narcotic prescription lasting for at least 90 days within the first 12 months after the index surgical procedure.
Of the 819 total patients, 499 (60.9%) patients had an active opioid prescription before surgery. Postoperatively, 813 (99.3%) received at least one narcotic prescription within 30 days of index surgery, and 162 (19.8%) continued with sustained opioid use in the 12 months after surgery. In adjusted analysis, patients with OD had a higher incidence of preoperative depression (P = 0.012) and preoperative opioid use (P < 0.001), as well as a higher frequency of preoperative benzodiazepine prescriptions (P = 0.009), and discharge MED value exceeding 120 mg/day (P = 0.013). Postoperative OD was observed in 7.5% of previously opioid-naïve patients.
This is the first study to test for an association between MED values prescribed at discharge and sustained opioid use after lumbar spine surgery. In addition to previously reported risk factors, discharge prescription dose exceeding 120 mg/day is independently associated with OD after spine surgery.
单机构回顾性队列研究。
确定在退行性指征下行椎间盘切除术或椎板切除术的患者出院时的处方实践是否与阿片类药物依赖（OD）相关。
脊柱手术中长期使用阿片类药物与更高的医疗保健利用率和更差的术后结果相关。在这一手术人群中，对出院时的处方实践的影响知之甚少。
对我们的高容量三级转诊中心在 2007 年至 2016 年期间进行的一项行政数据库查询进行了查询，以确定所有接受椎间盘切除术或椎板切除术的患者。对于纳入分析的患者，从电子健康记录中手动提取入院和出院时的阿片类药物处方数据，包括阿片类药物类型、频率、途径和剂量，然后转换为每日吗啡等效剂量（MED）值。我们将 OD 定义为在索引手术后 12 个月内连续使用至少 90 天的连续麻醉处方。
在 819 名患者中，499 名（60.9%）患者在手术前有活性阿片类药物处方。术后，813 名（99.3%）患者在索引手术后 30 天内至少收到一份麻醉处方，162 名（19.8%）患者在手术后 12 个月内继续持续使用阿片类药物。在调整分析中，OD 患者术前抑郁发生率更高（P=0.012）和术前阿片类药物使用（P<0.001），术前苯二氮䓬类药物处方频率更高（P=0.009），以及出院 MED 值超过 120mg/天（P=0.013）。在以前未使用过阿片类药物的患者中，有 7.5%观察到术后 OD。
这是第一项测试出院时 MED 值与腰椎手术后持续使用阿片类药物之间关联的研究。除了以前报道的危险因素外，出院时的处方剂量超过 120mg/天与脊柱手术后的 OD 独立相关。
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