Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, USA.
Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
Eur J Pain. 2020 Sep;24(8):1569-1584. doi: 10.1002/ejp.1610. Epub 2020 Jul 15.
BACKGROUND: Opioid use has increased to epidemic levels over the past decade within the United States, particularly among vulnerable populations. This retrospective study aimed to evaluate rates of prolonged opioid use in the Veteran population after thoracic surgery and identify specific risk clusters. METHODS: Veterans Administration data on patients who underwent thoracic surgery between January 1, 2006 and September 30, 2015 included preoperative opioid use information for stratification of patients to preoperative chronic opioid use (PCOU; n = 16,612) versus patients without preoperative chronic opioid use (WPCOU; n = 2,328). A Poisson regression model and prior literature were used to identify variables for use in a Latent Class Analysis (LCA) model for each stratum. Three-cluster models were selected, and identified as 'low-', 'intermediate-' and 'high-' risk groups. RESULTS: Cluster interpretations included: (a) Low risk: no psychiatric diagnoses, preoperative medication use, or preoperative chronic pain, (b) Intermediate risk: no psychiatric diagnoses, but had preoperative medication use and some preoperative chronic pain and (c) High risk: psychiatric diagnoses, preoperative medication use and preoperative chronic pain. For the PCOU stratum, rates of prolonged opioid use 1 year after surgery were as follows: 46.3%, 61.9% and 66.0%. For the WPCOU stratum, the observed rates were 4.7%, 8.3% and 9.2%. CONCLUSIONS: Prolonged opioid use trajectories obviously differ by PCOU status, as well as preoperative psychosocial diagnoses, medication use and chronic pain. This is a first step in population-level research to curb the rate of prolonged opioid use in Veterans following thoracic surgery. SIGNIFICANCE: This article presents population-level chronic opioid use trajectories after thoracic surgery, using latent class structures. Demographics, preoperative psychological diagnoses, medication usage and chronic pain variables were utilized to identify population-level clusters. The cluster identified as highest risk had preoperative chronic opioid use, psychological diagnoses, other medication prescriptions and chronic pain.
背景：在过去十年中，美国阿片类药物的使用已呈流行趋势，尤其是在弱势群体中。本回顾性研究旨在评估退伍军人胸部手术后长期使用阿片类药物的比率，并确定特定的风险群。
方法：退伍军人事务部（VA）在 2006 年 1 月 1 日至 2015 年 9 月 30 日期间接受胸部手术的患者数据，包括术前阿片类药物使用信息，用于分层患者为术前慢性阿片类药物使用（PCOU；n=16612）与无术前慢性阿片类药物使用（WPCOU；n=2328）。使用泊松回归模型和先前的文献，为每个分层确定用于潜在类别分析（LCA）模型的变量。选择了三聚类模型，并将其定义为“低”、“中”和“高”风险组。
结果：聚类解释包括：（a）低风险：无精神科诊断，术前用药或术前慢性疼痛；（b）中风险：无精神科诊断，但有术前用药和一些术前慢性疼痛；（c）高风险：精神科诊断，术前用药和术前慢性疼痛。对于 PCOU 分层，手术后 1 年延长阿片类药物使用的发生率分别为：46.3%，61.9%和 66.0%。对于 WPCOU 分层，观察到的发生率分别为 4.7%，8.3%和 9.2%。
结论：PCOU 状态以及术前的心理社会诊断，用药和慢性疼痛明显影响了长期阿片类药物使用的轨迹。这是在人群水平上研究抑制退伍军人胸部手术后长期使用阿片类药物的第一步。
意义：本文使用潜在类别结构介绍了胸部手术后的人群慢性阿片类药物使用轨迹。利用人口统计学，术前心理诊断，用药和慢性疼痛变量来确定人群水平的聚类。被确定为最高风险的聚类具有术前慢性阿片类药物使用，心理诊断，其他药物处方和慢性疼痛。
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