Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Ann Thorac Surg. 2020 Sep;110(3):829-835. doi: 10.1016/j.athoracsur.2019.12.031. Epub 2020 Jan 29.
Deaths from prescription opioid overdose are dramatically increasing. This study evaluates the incidence, risk factors, and cost of new persistent opioid use after aortic valve replacement, mitral valve replacement, and mitral valve repair.
Insurance claims from commercially insured patients who underwent aortic valve replacement, mitral valve replacement, mitral valve repair, or aortic valve replacement and mitral valve replacement/repair from 2014 to 2016 were evaluated. New persistent opioid use was defined as opioid-naive patients who filled an opioid prescription in the perioperative period and filled opioid prescriptions between 90 and 180 days postoperatively. Multivariable logistic regression identified risk factors for new persistent opioid use. Quantile regression evaluated the impact of new persistent opioid use on total healthcare payments in the 6 months after discharge.
Among 3404 opioid-naive patients undergoing aortic valve replacement, mitral valve replacement, or mitral valve repair, 188 (5.5%) had new persistent opioid use. Living in the southern United States (odds ratio, 1.89; 95% confidence interval, 1.35-2.63; P < .001) and increased opioids prescribed in the perioperative period (odds ratio, 1.009; 95% confidence interval, 1.006-1.012; P < .001) were independently associated with new persistent opioid use. After risk adjustment, new persistent opioid use was associated with a 2-fold higher number of emergency department visits (odds ratio, 2.21; 95% confidence interval, 1.61-3.03; P < .001) and a $5422 increase in healthcare payments in the 6 months after discharge.
New persistent opioid use is a significant and costly complication after aortic and mitral valve surgery in privately insured patients. Variation in regional susceptibility and opioid prescribing suggests that standardization may help prevent this complication.
处方类阿片药物过量导致的死亡人数正在大幅增加。本研究评估了主动脉瓣置换术、二尖瓣置换术和二尖瓣修复术后新发持续性阿片类药物使用的发生率、风险因素和成本。
评估了 2014 年至 2016 年期间接受主动脉瓣置换术、二尖瓣置换术、二尖瓣修复术或主动脉瓣置换术和二尖瓣置换/修复术的商业保险患者的保险索赔。新发持续性阿片类药物使用定义为围手术期内开具阿片类药物处方且术后 90-180 天内开具阿片类药物处方的阿片类药物初治患者。多变量逻辑回归确定了新发持续性阿片类药物使用的风险因素。分位数回归评估了新发持续性阿片类药物使用对出院后 6 个月内总医疗费用的影响。
在 3404 名接受主动脉瓣置换术、二尖瓣置换术或二尖瓣修复术的阿片类药物初治患者中，有 188 名（5.5%）发生了新发持续性阿片类药物使用。居住在美国南部（优势比，1.89；95%置信区间，1.35-2.63；P <.001）和围手术期开具的阿片类药物增加（优势比，1.009；95%置信区间，1.006-1.012；P <.001）与新发持续性阿片类药物使用独立相关。在风险调整后，新发持续性阿片类药物使用与急诊就诊次数增加 2 倍相关（优势比，2.21；95%置信区间，1.61-3.03；P <.001），并导致出院后 6 个月内医疗费用增加 5422 美元。
在私人保险患者中，主动脉瓣和二尖瓣手术后新发持续性阿片类药物使用是一种显著且昂贵的并发症。区域易感性和阿片类药物处方的差异表明，标准化可能有助于预防这种并发症。
