From the Division of Plastic Surgery, Department of Surgery, and the Department of Anesthesiology, Washington University School of Medicine; and the Section of Plastic Surgery, Department of Surgery, University of Michigan.
Plast Reconstr Surg. 2020 Mar;145(3):780-789. doi: 10.1097/PRS.0000000000006588.
Facial fractures are painful injuries routinely managed by opioids after surgical repair. Studies have identified patient risk factors and prescribing patterns associated with opioid use in medicine and general surgery; however, little is known about these entities in the facial trauma population.
A retrospective cohort study of opioid-naive patients undergoing surgical repair of facial fractures was conducted using the Truven Health MarketScan Commercial Claims and Encounters (2006 to 2015) and Medicaid Multi-State Databases (2011 to 2015). Eligible procedures included nasal, nasoorbitoethmoid, orbital, mandible, and Le Fort fracture repair. Opioid type, daily dosage, and prescription duration were analyzed. Multivariable logistic regression was performed to determine independent predictors of prescription refill.
A total of 20,191 patients undergoing surgical repair of facial fractures were identified. Of these, 15,861 patients (78.6 percent) filled a perioperative opioid prescription. Refill (58.7 percent) and potentially inappropriate prescribing (39.4 percent) were common among this population. Patient factors including prior substance use (adjusted OR, 1.84; 95 percent CI, 1.63 to 2.07) and history of mental health disorder (adjusted OR, 1.43; 95 percent CI, 1.06 to 1.91) were independent predictors of refill. Increased odds of refill were seen in patients prescribed tramadol (OR, 1.98; 95 percent CI, 1.48 to 2.66) and those who underwent multiple surgical repairs (OR, 3.38; 95 percent CI, 2.54 to 4.50).
Refill and potentially inappropriate prescribing occurred at high rates in facial trauma patients undergoing surgical repair. Additional studies are needed to develop guidelines for proper opioid prescribing in this population.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
面部骨折是一种疼痛性损伤，通常在手术后用阿片类药物进行治疗。已经有研究确定了与医学和普通外科中阿片类药物使用相关的患者风险因素和处方模式；然而，在面部创伤人群中，对于这些因素知之甚少。
使用 Truven Health MarketScan 商业索赔和就诊记录（2006 年至 2015 年）和 Medicaid 多州数据库（2011 年至 2015 年）进行了一项回顾性队列研究，纳入了接受手术修复面部骨折的阿片类药物初治患者。合格的手术包括鼻、鼻眶筛、眼眶、下颌骨和 Le Fort 骨折修复。分析了阿片类药物类型、日剂量和处方持续时间。采用多变量逻辑回归确定处方续开的独立预测因素。
共确定了 20191 名接受手术修复面部骨折的患者。其中，15861 名（78.6%）患者开具了围手术期阿片类药物处方。该人群中续开（58.7%）和潜在不适当处方（39.4%）很常见。患者因素包括既往药物滥用（校正比值比，1.84；95%置信区间，1.63 至 2.07）和精神健康障碍史（校正比值比，1.43；95%置信区间，1.06 至 1.91）是续开的独立预测因素。开曲马多（比值比，1.98；95%置信区间，1.48 至 2.66）和接受多次手术修复（比值比，3.38；95%置信区间，2.54 至 4.50）的患者续开的可能性更大。
在接受手术修复的面部创伤患者中，续开和潜在不适当处方的发生率很高。需要进一步研究以制定该人群中阿片类药物合理处方的指南。
临床问题/证据水平：风险，III。
