择期胸腰椎手术患者的阿片类药物使用趋势。
Opioid use trends in patients undergoing elective thoracic and lumbar spine surgery.
机构信息
From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Stratton, Wai, Kingwell, Phan); The Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey, El Koussy); the Division of Neurosurgery, Dalhousie University, Halifax, N.S. (Christie); the Department of Surgery, McGill Scoliosis & Spine Group, McGill University, Montreal, Que. (Jarzem); Victoria Hospital, London Health Sciences Centre, London, Ont. (Rasoulinejad); the Foothills Medical Centre, University of Calgary, Calgary, Alta. (Casha, Thomas); Université Laval, Québec, Que. (Paquet); the Winnipeg Spine Program, Health Sciences Centre, Winnipeg, Man. (Johnson); the Canada East Spine Centre, Saint John Regional Hospital, Saint John, N.B. (Abraham, Manson); the Department of Surgery, University of Toronto, Toronto, Ont. (Hall); Canadian Spine Outcomes and Research Network, Toronto, Ont.(McIntosh); Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont. (Rampersaud); and the Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C. (Fisher).
出版信息
Can J Surg. 2020 May 28;63(3):E306-E312. doi: 10.1503/cjs.018218.
BACKGROUND
Opioid use in North America has increased rapidly in recent years. Preoperative opioid use is associated with several negative outcomes. Our objectives were to assess patterns of opioid use over time in Canadian patients who undergo spine surgery and to determine the effect of spine surgery on 1-year postoperative opioid use.
METHODS
A retrospective analysis was performed on prospectively collected data from the Canadian Spine Outcomes and Research Network for patients undergoing elective thoracic and lumbar surgery. Self-reported opioid use at baseline, before surgery and at 1 year after surgery was compared. Baseline opioid use was compared by age, sex, radiologic diagnosis and presenting complaint. All patients meeting eligibility criteria from 2008 to 2017 were included.
RESULTS
A total of 3134 patients provided baseline opioid use data. No significant change in the proportion of patients taking daily (range 32.3%-38.2%) or intermittent (range 13.7%-22.5%) opioids was found from pre-2014 to 2017. Among patients who waited more than 6 weeks for surgery, the frequency of opioid use did not differ significantly between the baseline and preoperative time points. Significantly more patients using opioids had a chief complaint of back pain or radiculopathy than neurogenic claudication (p < 0.001), and significantly more were under 65 years of age than aged 65 years or older (p < 0.001). Approximately 41% of patients on daily opioids at baseline remained so at 1 year after surgery.
CONCLUSION
These data suggest that additional opioid reduction strategies are needed in the population of patients undergoing elective thoracic and lumbar spine surgery. Spine surgeons can be involved in identifying patients taking opioids preoperatively, emphasizing the risks of continued opioid use and referring patients to appropriate evidence-based treatment programs.
背景
近年来，北美阿片类药物的使用迅速增加。术前阿片类药物的使用与多种不良后果有关。我们的目的是评估加拿大接受脊柱手术的患者随时间推移的阿片类药物使用模式，并确定脊柱手术对术后 1 年阿片类药物使用的影响。
方法
对加拿大脊柱结果和研究网络前瞻性收集的接受择期胸腰椎手术患者的数据进行回顾性分析。比较了基线、术前和术后 1 年的自我报告阿片类药物使用情况。根据年龄、性别、影像学诊断和主要症状比较基线阿片类药物的使用情况。纳入了所有符合 2008 年至 2017 年入选标准的患者。
结果
共 3134 例患者提供了基线阿片类药物使用数据。从 2014 年之前到 2017 年，每天（范围 32.3%-38.2%）或间歇性（范围 13.7%-22.5%）使用阿片类药物的患者比例没有明显变化。对于等待手术时间超过 6 周的患者，基线和术前时间点的阿片类药物使用频率没有显著差异。使用阿片类药物的患者中，主诉腰痛或根性痛的患者明显多于神经源性跛行（p < 0.001），且明显比 65 岁以上的患者年龄更小（p < 0.001）。基线时每天服用阿片类药物的患者中，约有 41%在术后 1 年仍继续服用。
结论
这些数据表明，在接受择期胸腰椎手术的患者人群中，需要采取额外的阿片类药物减少策略。脊柱外科医生可以参与识别术前服用阿片类药物的患者，强调继续使用阿片类药物的风险，并将患者转介到适当的基于证据的治疗计划中。
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