Columbia University Vagelos College of Physicians and Surgeons, the Joseph L. Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center, Columbia University, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York; and Rutgers Robert Wood Johnson Medical School, New Brunswick, and the Environmental and Occupational Health Sciences Institute (EOHSI), Rutgers, Piscataway, New Jersey.
Obstet Gynecol. 2020 Sep;136(3):565-575. doi: 10.1097/AOG.0000000000003948.
To compare perioperative use and persistent postoperative opioid use among Medicaid-insured women and commercially insured women who underwent gynecologic surgery for benign indications.
The Truven Health MarketScan database, a nationwide data source collecting commercial insurance claims across all states and Medicaid insurance claims from 12 states, was used to identify opioid-naïve women without cancer aged 18-64 years who underwent common gynecologic surgeries from 2012 to 2016 and filled a prescription for an opioid perioperatively. Persistent opioid use was defined as filling an opioid prescription 90-180 days after the surgery. Opioid use disorder (OUD) was defined as hospitalizations or emergency department visits for opioid dependence, misuse, or overdose. Multivariable models were developed to examine the insurance-associated disparity in persistent opioid use and OUD.
A total of 31,155 Medicaid-insured women and 270,716 commercially insured women were identified. Medicaid-insured women received greater quantities of opioids and for longer durations than did commercially insured women. Persistent postoperative opioid use was identified in 14.1% of Medicaid-insured women and 5.8% of commercially insured women (P<.001). More opioid prescriptions filled, longer days supplied, and higher total doses perioperatively contributed most to the prediction of persistent opioid use. Medicaid-insured patients who persistently used opioids were two times more likely to develop OUD than commercially insured patients (16.8% vs 5.1% adjusted relative risk 1.99; 99% CI 1.26-3.15).
Medicaid-insured women received larger quantities of opioids perioperatively, were more likely to use them persistently, and were more likely to develop OUD than commercially insured women.
比较接受妇科良性指征手术的医疗补助保险参保女性和商业保险参保女性围手术期和持续术后阿片类药物使用情况。
使用 Truven Health MarketScan 数据库（一个全国性数据源，涵盖所有州的商业保险索赔和 12 个州的医疗补助保险索赔），确定 2012 年至 2016 年期间无癌症、年龄在 18-64 岁之间、接受常见妇科手术且术后开具阿片类药物处方的阿片类药物初治女性。持续使用阿片类药物定义为术后 90-180 天内开具阿片类药物处方。阿片类药物使用障碍（OUD）定义为因阿片类药物依赖、滥用或过量而住院或到急诊就诊。建立多变量模型以研究保险相关的持续使用阿片类药物和 OUD 的差异。
共确定了 31155 名医疗补助保险参保女性和 270716 名商业保险参保女性。医疗补助保险参保女性接受的阿片类药物数量多于商业保险参保女性，持续时间也长于商业保险参保女性。医疗补助保险参保女性中有 14.1%持续使用术后阿片类药物，商业保险参保女性中有 5.8%（P<.001）。围手术期开具的阿片类药物处方更多、供应天数更长和总剂量更高是预测持续使用阿片类药物的主要因素。持续使用阿片类药物的医疗补助保险参保患者发生 OUD 的可能性是商业保险参保患者的两倍（16.8%比 5.1%，调整后的相对风险 1.99；99%置信区间 1.26-3.15）。
医疗补助保险参保女性围手术期接受的阿片类药物数量更大，持续使用的可能性更高，发生 OUD 的可能性也高于商业保险参保女性。
