Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Tex.
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Tex.
J Thorac Cardiovasc Surg. 2020 Feb;159(2):691-702.e5. doi: 10.1016/j.jtcvs.2019.09.059. Epub 2019 Sep 27.
We sought to identify whether chronic opioid users are at increased risk for complications or hospital readmission following lobectomy for non-small cell lung cancer.
The National Cancer Institute Surveillance, Epidemiology, and End Results-Medicare database was queried to identify patients older than age 65 years who received a lobectomy for non-small cell lung cancer. Chronic opioid users were identified through Medicare Part D records and were defined as those with >120 cumulative days of opioid supply for the year before surgery. A systematic 1:2 propensity matching was performed among chronic opioid users.
Six thousand four hundred thirty-seven patients were identified, among whom 3627 (56%) were opioid naïve, 1866 (29%) were intermittent opioid users, and 944 (15%) were chronic opioid users. After propensity matching, 30-day mortality and 90-day mortality were nearly 2-fold higher among chronic opioid users compared with nonchronic users. In addition, length of stay and hospital charges were increased among chronic opioid users (median, 6 vs 7 days and mean increase, $12,526, respectively). Multivariable analysis revealed that intermittent opioid users and chronic opioid users were associated with an increased risk of 90-day hospital readmission compared with opioid-naïve patients (odds ratio, 1.35; 95% confidence interval, 1.07-1.71 and odds ratio, 1.72; 95% confidence interval, 1.40-2.12, respectively), predominantly burdened by infectious, renal, and pulmonary causes.
Patients who chronically use opioids before lobectomy represent high-risk patients. The risk of 30- and 90-day mortality, length of stay, hospital charges, and 90-day readmission after lobectomy among chronic opioid users are substantially elevated.
我们旨在确定慢性阿片类药物使用者在接受非小细胞肺癌肺叶切除术后是否有更高的并发症或再入院风险。
国家癌症研究所监测、流行病学和最终结果-医疗保险数据库被查询，以确定年龄大于 65 岁的接受非小细胞肺癌肺叶切除术的患者。通过医疗保险 D 部分记录确定慢性阿片类药物使用者，并将其定义为手术前一年接受>120 天阿片类药物供应的患者。对慢性阿片类药物使用者进行了系统的 1:2 倾向匹配。
共确定了 6437 例患者，其中 3627 例（56%）为阿片类药物无使用史，1866 例（29%）为间歇性阿片类药物使用者，944 例（15%）为慢性阿片类药物使用者。经过倾向匹配后，与非慢性使用者相比，慢性阿片类药物使用者的 30 天和 90 天死亡率几乎高出两倍。此外，慢性阿片类药物使用者的住院时间和住院费用也增加（中位数，6 天与 7 天，平均增加 12526 美元）。多变量分析显示，与阿片类药物无使用史的患者相比，间歇性阿片类药物使用者和慢性阿片类药物使用者的 90 天再入院风险增加（比值比，1.35；95%置信区间，1.07-1.71 和比值比，1.72；95%置信区间，1.40-2.12），主要与感染、肾脏和肺部疾病有关。
在接受肺叶切除术之前长期使用阿片类药物的患者属于高风险患者。慢性阿片类药物使用者的 30 天和 90 天死亡率、住院时间、住院费用和肺叶切除术后 90 天再入院风险显著升高。
