Department of Anaesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy Management and Evaluation, Toronto, ON, Canada; ICES, Toronto, ON, Canada.
Institute of Health Policy Management and Evaluation, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada; ICES, Toronto, ON, Canada.
Br J Anaesth. 2020 Mar;124(3):281-291. doi: 10.1016/j.bja.2019.12.006. Epub 2020 Jan 27.
Many patients use opioids chronically before surgery; it is unclear if surgery alters the likelihood of ongoing opioid consumption in these patients.
We performed a population-based matched cohort study of adults in Ontario, Canada undergoing one of 16 non-orthopaedic surgical procedures and who were chronically using opioids, defined as (1) an opioid prescription that overlapped the index date and (2) either a total of 120 or more cumulative calendar days of filled opioid prescriptions, or 10 or more prescriptions filled in the prior year. Each surgical patient was matched based on age, sex, Charlson comorbidity index, and daily preoperative opioid dose to three non-surgical patients who were also chronic opioid users. The primary outcome was time to opioid discontinuation.
The cohort included 4755 surgical and 14 265 matched non-surgical patients. After adjustment for sociodemographic characteristics and comorbidities, surgery was associated with an increased likelihood of opioid discontinuation (adjusted hazard ratio: 1.34, 95% confidence interval [CI]: 1.27, 1.42). Among surgical patients, factors associated with a reduced odds of discontinuation included a mean preoperative opioid dose above 90 morphine milligram equivalents (adjusted odds ratio [aOR]: 0.39; 95% CI: 0.32, 0.49) or filling a prescription for oxycodone (aOR: 0.73; 95% CI: 0.56, 0.98). Receipt of an in-patient Acute Pain Service consultation (aOR: 1.34; 95% CI: 1.06, 1.69) or residing in the highest neighbourhood income quintile (aOR: 1.35; 95% CI: 1.04, 1.79) were associated with a greater odds of opioid discontinuation.
For chronic opioid users, surgery was associated with an increased likelihood of discontinuation of opioids in the following year compared with non-surgical chronic opioid users.
许多患者在手术前长期使用阿片类药物；目前尚不清楚手术是否会改变这些患者持续使用阿片类药物的可能性。
我们在加拿大安大略省进行了一项基于人群的匹配队列研究，纳入接受 16 种非骨科手术的成年人，这些患者长期使用阿片类药物，定义为：（1）与索引日期重叠的阿片类药物处方；（2）或总共使用 120 天或更多的累积天数的阿片类药物处方，或在过去一年中使用 10 剂或更多的阿片类药物处方。每个手术患者均根据年龄、性别、Charlson 合并症指数和术前每日阿片类药物剂量与 3 名非手术慢性阿片类药物使用者进行匹配。主要结局是阿片类药物停药时间。
该队列包括 4755 名手术患者和 14265 名匹配的非手术患者。调整社会人口统计学特征和合并症后，手术与阿片类药物停药的可能性增加相关（调整后的危险比：1.34，95%置信区间[CI]：1.27，1.42）。在手术患者中，与减少停药几率相关的因素包括术前阿片类药物平均剂量高于 90 吗啡毫克当量（调整后的优势比[aOR]：0.39；95%CI：0.32，0.49）或开具羟考酮处方（aOR：0.73；95%CI：0.56，0.98）。接受住院急性疼痛服务咨询（aOR：1.34；95%CI：1.06，1.69）或居住在收入最高的五分位数街区（aOR：1.35；95%CI：1.04，1.79）与阿片类药物停药的几率增加相关。
对于慢性阿片类药物使用者，与非手术慢性阿片类药物使用者相比，手术与下一年停止使用阿片类药物的可能性增加相关。
