Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Spine J. 2020 Nov;20(11):1798-1804. doi: 10.1016/j.spinee.2020.06.005. Epub 2020 Jun 11.
Reliable estimation of the likelihood for prolonged postoperative opioid use may aid targeted interventions for high-risk patients. Previous studies have recommended differing methodologies for prediction of sustained postoperative opioid use.
To compare the performance of the Stopping Opioids after Surgery (SOS) score and preoperative morphine milligram equivalents (MME) for postoperative opioid prescription exposure in a contemporary cohort of lumbar surgery patients.
Adult patients undergoing posterior decompression with or without fusion for degenerative lumbar conditions between January 31, 2016 and May 31, 2019.
STUDY DESIGN/SETTING: Retrospective review at two academic medical centers and three community hospitals.
The primary outcome was sustained postoperative prescription opioid exposure at 3 months and 6 months. Reoperations and readmissions were considered secondarily.
The Stopping Opioids after Surgery score and MME were assigned to patients based on data from their preoperative surgical evaluation. Performance for both measures was assessed for all outcomes by discrimination, including c-statistic and receiver-operating curve analysis. Calibration of the low, medium and high-risk strata with the observed rates of postoperative adverse events were examined.
Overall, 4,165 patients were included in this study. Preoperative prevalence of prescription opioid use was 31%. Rates of postoperative opioid prescriptions at 3 months and 6 months, were 3.3% (n=136) and 1.5% (n=61). The c-statistics of preoperative oral MME and SOS score for 3-month sustained opioid prescriptions were 0.64 and 0.78, respectively. The c-statistics of preoperative oral MME and SOS score for 6-month sustained opioid prescriptions were 0.64 and 0.82, respectively. C-statistics of preoperative oral MME and SOS score were much lower for reoperation and readmission, although SOS score outperformed MME for both outcomes.
The SOS score clinically outperformed oral MME as a predictive measure for outcomes following lumbar spine surgery. The SOS score may be valuable for identifying individuals at high-risk for sustained prescription opioid use and associated adverse events following spine surgery.
可靠地估计术后长期使用阿片类药物的可能性有助于针对高危患者进行有针对性的干预。先前的研究已经为持续术后阿片类药物使用的预测推荐了不同的方法。
比较 Stopping Opioids after Surgery（SOS）评分和术前吗啡毫克当量（MME）在腰椎手术患者当代队列中预测术后阿片类药物处方暴露的性能。
2016 年 1 月 31 日至 2019 年 5 月 31 日期间接受后路减压术伴或不伴融合治疗退行性腰椎疾病的成年患者。
研究设计/地点：在两个学术医疗中心和三个社区医院进行回顾性研究。
主要结果是术后 3 个月和 6 个月持续处方阿片类药物暴露。再次手术和再入院被认为是次要结果。
根据术前手术评估中的数据，为患者分配 Stopping Opioids after Surgery 评分和 MME。通过区分度评估两种方法在所有结局中的表现，包括 C 统计量和接受者操作特征曲线分析。检查低、中、高危分层与术后不良事件发生率的校准。
总体而言，这项研究纳入了 4165 名患者。术前处方阿片类药物使用率为 31%。术后 3 个月和 6 个月的阿片类药物处方率分别为 3.3%（n=136）和 1.5%（n=61）。术前口服 MME 和 SOS 评分预测 3 个月持续使用阿片类药物的 C 统计量分别为 0.64 和 0.78。术前口服 MME 和 SOS 评分预测 6 个月持续使用阿片类药物的 C 统计量分别为 0.64 和 0.82。尽管 SOS 评分在这两种结局中都优于 MME，但对于再次手术和再入院，术前口服 MME 和 SOS 评分的 C 统计量要低得多。
SOS 评分作为腰椎手术后结果的预测指标，在临床表现优于口服 MME。SOS 评分可能对识别术后脊柱手术中持续使用处方阿片类药物和相关不良事件风险较高的个体具有重要价值。
