Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas.
Ann Thorac Surg. 2020 Jan;109(1):194-202. doi: 10.1016/j.athoracsur.2019.06.095. Epub 2019 Aug 22.
Opioids represent the mainstay for treating postsurgical pain but can cause significant morbidity in addition to dependency. The aim of the study was to determine the incidence of persistent opioid use after lung surgery.
Patients who underwent lung resection from 2008 to 2013 for non-small cell lung cancer were identified in the Surveillance, Epidemiology and End Results-Medicare database. Patients were categorized as being chronic, intermittent, or naïve preoperative opioid users using information obtained from part D records. Persistent opioid use was defined as having a filled opioid prescription between 3 and 6 months after lung resection.
A total of 6948 patients were identified, among whom 3946 (56.8%) were opioid naïve, 2017 (29.0%) were intermittent opioid users, and 985 (14.2%) were chronic opioid users preoperatively. Persistent opioid use (3-6 months) after lung resection was high (31%), even among opioid-naïve patients (17%). Among those who were previously opioid naïve, independent predictors of persistent opioid use were receipt of adjuvant radiation or chemotherapy, less than 70 years of age, Charlson comorbidity score of 1 or 2, and residence in zip codes associated with lower education. Conversely, patients who underwent minimally invasive surgery were less likely to have persistent opioid use. Those with persistent opioid use after surgery did not show any trend toward returning to preoperative opioid utilization for at least the first postoperative year.
Opioid dependence after lung resection in the population over 65 years of age is high but was significantly lower among those who received minimally invasive surgery, in addition to other factors.
阿片类药物是治疗术后疼痛的主要药物，但除了依赖性外，还会引起显著的发病率。本研究的目的是确定肺癌手术后持续使用阿片类药物的发生率。
从监测、流行病学和最终结果-医疗保险数据库中确定了 2008 年至 2013 年间因非小细胞肺癌接受肺切除术的患者。使用来自第 D 部分记录的信息，将患者分为慢性、间歇性或术前阿片类药物无使用史的患者。持续使用阿片类药物定义为在肺切除术后 3 至 6 个月内有阿片类药物处方。
共确定了 6948 例患者，其中 3946 例（56.8%）为阿片类药物无使用史，2017 例（29.0%）为间歇性阿片类药物使用者，985 例（14.2%）为术前慢性阿片类药物使用者。肺切除术后（3-6 个月）持续使用阿片类药物的比例较高（31%），即使在阿片类药物无使用史的患者中（17%）也是如此。在那些以前没有使用过阿片类药物的患者中，持续使用阿片类药物的独立预测因素是接受辅助放疗或化疗、年龄小于 70 岁、Charlson 合并症评分为 1 或 2 分，以及居住在与教育程度较低相关的邮政编码区。相反，接受微创手术的患者不太可能持续使用阿片类药物。术后持续使用阿片类药物的患者在至少术后第一年没有恢复术前阿片类药物使用的趋势。
在 65 岁以上人群中，肺切除术后阿片类药物依赖的发生率较高，但接受微创手术的患者以及其他因素的发生率显著降低。
