Sunnybrook Research Institute, Toronto, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
Pharmacoepidemiol Drug Saf. 2020 Apr;29(4):504-509. doi: 10.1002/pds.4964. Epub 2020 Feb 13.
Opioids are commonly prescribed for acute pain after surgery. However, it is unclear whether these prescriptions are usually modified to account for patient age and, in particular, opioid-related risks among older adults. We therefore sought to describe postoperative opioid prescriptions filled by opioid-naïve adults undergoing four common surgical procedures.
This retrospective cohort study used individually linked surgery and prescription opioid dispensing data from Ontario, Canada to create a population-based sample of 135 659 opioid-naïve adults who underwent one of four surgical procedures (laparoscopic cholecystectomy, laparoscopic appendectomy, knee meniscectomy, or breast excision) between 2013 and 2017. Patient age, in years, was categorized as 18 to 64, 65 to 69, 70 to 74, and 75 and over. Postoperative opioid prescriptions were identified as those filled on or within 6 days of surgical discharge date. For those who filled a prescription, we assessed the total morphine milligram equivalent (MME) dose, types of opioids, and any subsequent opioid prescriptions filled within 30 days of surgical discharge date. Results were presented stratified by surgical procedure.
For three of the four surgical procedures we assessed, the proportion of patients who filled a postoperative opioid prescription decreased with age (P < 0.001 for trend), and there was a small shift in the type of opioid (more codeine or tramadol and less oxycodone; P < 0.001 for trend). However, the total MME dose of the initial prescription(s) filled showed minimal age-related trends.
The proportion of opioid-naïve patients filling postoperative opioid prescriptions decreases with age. However, postoperative opioid prescription dosage is not typically different in older adults.
阿片类药物常用于术后急性疼痛的治疗。然而，目前尚不清楚这些处方是否通常会根据患者年龄进行调整，特别是调整老年患者的阿片类药物相关风险。因此，我们旨在描述接受四种常见手术的阿片类药物初治成年人的术后阿片类药物处方。
本回顾性队列研究使用来自加拿大安大略省的手术和处方阿片类药物配药的个体链接数据，创建了一个基于人群的样本，其中包括 135659 名阿片类药物初治成年人，他们在 2013 年至 2017 年期间接受了四种手术之一（腹腔镜胆囊切除术、腹腔镜阑尾切除术、膝关节半月板切除术或乳房切除术）。患者年龄以 18 至 64 岁、65 至 69 岁、70 至 74 岁和 75 岁及以上进行分类。术后阿片类药物处方定义为在手术出院日期当天或之后 6 天内开具的处方。对于那些开具了处方的患者，我们评估了总吗啡毫克当量（MME）剂量、阿片类药物类型以及在手术出院日期后 30 天内开具的任何后续阿片类药物处方。结果按手术类型分层呈现。
在所评估的四种手术中的三种手术中，随着年龄的增长，开具术后阿片类药物处方的患者比例降低（趋势 P<0.001），阿片类药物类型也略有变化（更多的可待因或曲马多，更少的羟考酮；趋势 P<0.001）。然而，初始处方（多个）的总 MME 剂量与年龄相关的趋势较小。
阿片类药物初治患者开具术后阿片类药物处方的比例随年龄增长而降低。然而，老年患者的术后阿片类药物处方剂量通常没有差异。
