School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, FL, USA.
Clin Neurol Neurosurg. 2020 Oct;197:106161. doi: 10.1016/j.clineuro.2020.106161. Epub 2020 Aug 19.
The incidence of chronic opioid use (COU) is increasing with health related complications impacting both patients and healthcare services.
The aim of this study was to identify the impact of COU on postoperative urinary retention (PUR) in patients following lumbar fusion surgery as well as its impact on length of stay (LOS) and non-routine discharges (NRD).
MATERIALS & METHODS: The State Inpatient Databases were utilised to identify patients undergoing elective lumbar fusion procedures. Patients with and without COU were separated into groups and matched using 3:1 propensity score matching. PUR, LOS in the upper quartile and discharge to a location other than home were the outcomes of interest. Multivariable logistic regression was used to examine the impact of COU on the above outcomes and Wald chi-square tests were used to determine the factors with the most significant associations.
COU was significant for PUR (p = 0.037), prolonged LOS (p < 0.001), and NRD (p < 0.001). Factors most significantly associated with PUR were Elixhauser Mortality Index and COU both with p < 0.05. Factors associated with prolonged LOS and NRD were Elixhauser Mortality Index, COU, and insurance status.
COU has a notable impact on PUR, LOS, and NRD. The Elixhauser Mortality Index and insurance status of patients also showed predictive utility for these outcomes. This knowledge enables us to identify sources of pressure for health services and approach them strategically through increased awareness.
慢性阿片类药物使用（COU）的发生率随着与健康相关的并发症的增加而增加，这些并发症对患者和医疗服务都有影响。
本研究旨在确定 COU 对腰椎融合手术后患者术后尿潴留（PUR）的影响，以及对住院时间（LOS）和非常规出院（NRD）的影响。
利用州住院患者数据库确定接受择期腰椎融合手术的患者。将有和没有 COU 的患者分为两组，并使用 3:1 的倾向评分匹配进行匹配。PUR、LOS 处于上四分位数和出院到非家庭地点是感兴趣的结果。多变量逻辑回归用于检查 COU 对上述结果的影响，Wald 卡方检验用于确定具有最显著关联的因素。
COU 与 PUR（p=0.037）、延长 LOS（p<0.001）和 NRD（p<0.001）显著相关。与 PUR 最显著相关的因素是 Elixhauser 死亡率指数和 COU，两者均为 p<0.05。与 LOS 延长和 NRD 相关的因素是 Elixhauser 死亡率指数、COU 和保险状况。
COU 对 PUR、LOS 和 NRD 有显著影响。患者的 Elixhauser 死亡率指数和保险状况也显示出对这些结果的预测效用。这些知识使我们能够识别医疗服务的压力源，并通过提高认识来战略性地应对这些压力源。
