Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina; Department of Population Health Sciences, Duke University, Durham, North Carolina; Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina.
Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina; Department of Population Health Sciences, Duke University, Durham, North Carolina; Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina.
Surg Obes Relat Dis. 2020 Aug;16(8):1100-1110. doi: 10.1016/j.soard.2020.04.037. Epub 2020 May 7.
Opioid analgesics are often prescribed to manage pain after bariatric surgery, which may develop into chronic prescription opioid use (CPOU) in opioid-naïve patients. Bariatric surgery may affect opioid use in those with or without presurgical CPOU.
To compare CPOU persistence and incidence in a large multisite cohort of veterans undergoing bariatric surgery (open Roux-en-Y gastric bypass, laparoscopic RYGB, or laparoscopic sleeve gastrectomy) and matched nonsurgical controls.
Veterans Administration hospitals.
In a retrospective cohort study, we matched 1117 surgical patients with baseline CPOU to 9531 nonsurgical controls, and 2822 surgical patients without CPOU at baseline to 26,392 nonsurgical controls using sequential stratification. CPOU persistence in veterans with baseline CPOU was estimated using generalized estimating equations by procedure type. CPOU incidence in veterans without baseline CPOU was estimated in Cox regression models by procedure type because postoperative pain, complications, and absorption may differ by procedure.
In veterans with baseline CPOU, postsurgical CPOU declined over time for each surgical procedure; these trends did not differ between surgical patients and nonsurgical controls. In veterans without baseline CPOU, compared with nonsurgical controls, bariatric patients had higher CPOU incidence within 5 years after open Roux-en-Y gastric bypass (hazard ratio = 1.19; 95% confidence interval: 1.06-1.34) or laparoscopic open Roux-en-Y gastric bypass (hazard ratio = 1.22, 95% confidence interval: 1.06-1.41). Veterans undergoing laparoscopic sleeve gastrectomy had higher CPOU incidence 1 to 5 years after surgery (hazard ratio = 1.28; 95% confidence interval: 1.05-1.56) than nonsurgical controls.
Bariatric surgery was associated with greater risk of CPOU incidence in patients without baseline CPOU but was not associated with greater CPOU persistence.
阿片类镇痛药常用于治疗术后肥胖患者的疼痛，在阿片类药物初治患者中可能会发展为慢性处方阿片类药物使用（CPOU）。肥胖手术可能会影响有或没有术前 CPOU 的患者的阿片类药物使用。
比较大型多站点退伍军人队列中接受肥胖手术（开放 Roux-en-Y 胃旁路手术、腹腔镜 RYGB 或腹腔镜袖状胃切除术）和匹配的非手术对照患者的 CPOU 持续时间和发生率。
退伍军人事务部医院。
在回顾性队列研究中，我们使用序贯分层法将基线 CPOU 的 1117 例手术患者与 9531 例非手术对照患者匹配，将基线时无 CPOU 的 2822 例手术患者与 26392 例非手术对照患者匹配。使用广义估计方程根据手术类型估计基线时 CPOU 的退伍军人 CPOU 持续时间。对于基线时无 CPOU 的退伍军人，使用 Cox 回归模型根据手术类型估计 CPOU 的发生率，因为术后疼痛、并发症和吸收可能因手术类型而异。
在基线时 CPOU 的退伍军人中，随着时间的推移，每种手术方法的术后 CPOU 均呈下降趋势；这些趋势在手术患者和非手术对照患者之间没有差异。在基线时无 CPOU 的退伍军人中，与非手术对照相比，接受肥胖手术的患者在 Roux-en-Y 胃旁路手术（风险比=1.19；95%置信区间：1.06-1.34）或腹腔镜 Roux-en-Y 胃旁路手术（风险比=1.22；95%置信区间：1.06-1.41）后 5 年内 CPOU 发生率更高。接受腹腔镜袖状胃切除术的退伍军人在手术后 1 至 5 年内 CPOU 发生率更高（风险比=1.28；95%置信区间：1.05-1.56）比非手术对照。
肥胖手术与无基线 CPOU 的患者 CPOU 发生率增加相关，但与 CPOU 持续时间增加无关。
