Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
Acta Anaesthesiol Scand. 2021 Jan;65(1):47-57. doi: 10.1111/aas.13688. Epub 2020 Sep 9.
Knowledge of chronic opioid use after cardiac surgery is sparse. We therefore aimed to describe the proportion of new chronic post-operative opioid use after open cardiac surgery.
We used prospectively registered data from a national prescription registry and a clinical registry of 29 815 first-time cardiac surgeries from three Danish university hospitals. Data collection spanned from 2003 to 2016. The main outcome was chronic post-operative opioid use, defined as at least one opioid dispensing in the fourth post-operative quarter. Data were assessed for patient-level predictors of chronic post-operative opioid use, including pre-operative opioid use, opioid use at discharge, comorbidities, and procedural related variables.
The overall proportion of post-operative opioid use was 10.6% (95% CI: 10.2-10.9). The proportion of new chronic post-operative opioid use was 5.7% (95% CI: 5.5-6.0) among pre-operative opioid naïve patients. The corresponding proportions among patients, who pre-operatively used low or high dose opioid (1-500 mg or > 500 mg cumulative morphine equivalent opioid), were 68.3% (95% CI: 66.1-70.4) and 76.3% (95% CI: 74.0-78.5) respectively. Risk factors associated with new chronic post-operative opioid use included: female gender, underweight and obesity, pre-operative comorbidities, acute surgery, ICU-time > 1 day, and post-operative complications. Strongest predictor of chronic post-operative opioid use was post-discharge use of opioid within one month after surgery (odds ratio 3.3, 95% CI: 2.8-4.0).
New chronic post-operative opioid use after open cardiac surgery is common. Focus on post-discharge opioid use may help clinicians to reduce rates of new chronic opioid users.
关于心脏手术后慢性阿片类药物使用的知识有限。因此，我们旨在描述开胸心脏手术后新出现的慢性术后阿片类药物使用的比例。
我们使用了来自丹麦三所大学医院的国家处方登记处和临床登记处的前瞻性注册数据，涵盖了 29815 例首次心脏手术。数据收集时间为 2003 年至 2016 年。主要结果是慢性术后阿片类药物使用，定义为术后第四个季度至少有一次阿片类药物配药。评估了患者水平的预测因素，包括术前阿片类药物使用、出院时阿片类药物使用、合并症和与程序相关的变量。
术后阿片类药物使用的总体比例为 10.6%（95%CI：10.2-10.9）。在术前未使用阿片类药物的患者中，新出现慢性术后阿片类药物使用的比例为 5.7%（95%CI：5.5-6.0）。而在术前使用低剂量或高剂量阿片类药物（1-500mg 或＞500mg 累积吗啡等效阿片类药物）的患者中，这一比例分别为 68.3%（95%CI：66.1-70.4）和 76.3%（95%CI：74.0-78.5）。与新出现慢性术后阿片类药物使用相关的危险因素包括：女性、体重过轻和肥胖、术前合并症、急性手术、入住 ICU 时间＞1 天和术后并发症。慢性术后阿片类药物使用的最强预测因素是术后一个月内手术后的阿片类药物出院后使用（优势比 3.3，95%CI：2.8-4.0）。
开胸心脏手术后新出现的慢性术后阿片类药物使用较为常见。关注术后阿片类药物的使用可能有助于临床医生降低新的慢性阿片类药物使用者的比例。
