偏头痛治疗与偏头痛患者术后相关疼痛导致的住院再入院风险。

Migraine treatment and the risk of postoperative, pain-related hospital readmissions in migraine patients.

机构信息

Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.

Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

出版信息

Cephalalgia. 2020 Dec;40(14):1622-1632. doi: 10.1177/0333102420949857. Epub 2020 Aug 24.

DOI:10.1177/0333102420949857

PMID:32838537

Abstract

BACKGROUND

Migraine treatment may mitigate migraine and associated pain in the perioperative period.

OBJECTIVE

The aim of the study was to estimate the effect of perioperative acute and prophylactic migraine treatment on the risk of postoperative 30-day hospital readmission with an admitting diagnosis specifying any pain complaints among migraine patients.

DESIGN

Electronic health records were analysed for 21,932 adult migraine patients undergoing surgery between 2005 and 2017 at Beth Israel Deaconess Medical Center and Massachusetts General Hospital in Boston, Massachusetts, USA.

METHODS

Perioperative abortive migraine treatment was defined as guideline-recommended medication (triptan, ergotamine, acetaminophen, nonsteroidal anti-inflammatory drug) prescription after surgery, within 30 days after discharge and prior readmission. Perioperatively continued prophylactic migraine treatment was defined as prescription both prior to surgery and perioperatively for recommended medications (beta-blockers, antidepressants, antiepileptics, onabotulinumtoxin A).

RESULTS

Overall, 10,921 (49.8%) patients received a prescription for abortive migraine drugs. Of these, 1.2% and 1.5% of patients with and without such prescription were readmitted for pain, respectively. Patients with abortive treatment had lower odds of pain-related readmission (adjusted odds ratio 0.63 [95% confidence interval 0.49-0.81]). Prophylactic migraine treatment showed no effect on pain-related readmission independently of acute treatment (adjusted odds ratio 0.97 [95% confidence interval 0.72-1.32]).

CONCLUSIONS

Migraine patients undergoing surgery with a perioperative prescription for abortive migraine drugs were at decreased risk of pain-related hospital readmission.

摘要

背景

偏头痛治疗可能会减轻围手术期的偏头痛和相关疼痛。

目的

本研究旨在评估围手术期急性和预防性偏头痛治疗对偏头痛患者术后 30 天因任何疼痛主诉再次入院的风险的影响。

设计

分析了 2005 年至 2017 年间在美国马萨诸塞州波士顿贝斯以色列女执事医疗中心和马萨诸塞州总医院接受手术的 21932 例成年偏头痛患者的电子健康记录。

方法

围手术期偏头痛治疗被定义为手术后 30 天内出院后和再次入院前使用指南推荐的药物（曲普坦、麦角胺、对乙酰氨基酚、非甾体抗炎药）进行的偏头痛治疗。围手术期预防性偏头痛治疗被定义为术前和围手术期使用推荐药物（β受体阻滞剂、抗抑郁药、抗癫痫药、肉毒杆菌毒素 A）的处方。

结果

总体而言，10921 例（49.8%）患者接受了偏头痛药物的处方。其中，有和没有此类处方的患者因疼痛再次入院的比例分别为 1.2%和 1.5%。接受偏头痛治疗的患者疼痛相关再入院的可能性较低（调整后的优势比 0.63[95%置信区间 0.49-0.81]）。预防性偏头痛治疗与急性治疗无关，对疼痛相关再入院无影响（调整后的优势比 0.97[95%置信区间 0.72-1.32]）。