Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Missouri.
Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri.
Ann Thorac Surg. 2021 Jun;111(6):1849-1857. doi: 10.1016/j.athoracsur.2020.07.043. Epub 2020 Oct 1.
Preoperative opioid use is associated with increased health care use after elective abdominal surgery. However, the scope of preoperative opioid use and its association with outcomes have not been described in elective pulmonary resection. This study aimed to characterize prevalent preoperative opioid use in patients undergoing elective pulmonary resection and compare clinical outcomes between patients with and without preoperative opioid exposure.
The study investigators assembled a retrospective cohort of adult patients undergoing elective pulmonary resection by using the IBM Watson Health MarketScan Database (2007 to 2015). The study compared opioid-naïve patients with patients with a history of preoperative opioid exposure (>0 morphine milligram equivalent prescription filled within 90 days before surgery). Multivariable logistic and linear regressions adjusting for patient sociodemographic, comorbidity, and operative characteristics were used to compare odds of postoperative complication, prolonged length-of-stay (>14 days), 30-day postdischarge emergency department visits, 90-day readmissions, and 90-day costs.
The study identified 14,373 patients, 4502 (31.3%) of whom had opioid exposure before pulmonary resection. In multivariable regression, patients with preoperative opioid exposure had significantly higher odds of experiencing a prolonged length of stay (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.11 to 1.58), 30-day emergency department visits (OR, 1.24; 95% CI, 1.01 to 1.41), and 90-day readmissions (OR, 1.41; 95% CI, 1.28 to 1.55). Adjusted 90-day costs were approximately 5% higher for patients with preoperative opioid use (P < .001).
One-third of patients who underwent pulmonary resection used opioids preoperatively and were at risk of experiencing adverse outcomes and having significantly higher health care use. They represent a unique high-risk population that will require novel, targeted interventions.
择期腹部手术后，术前使用阿片类药物与增加医疗保健使用相关。然而，术前阿片类药物的使用范围及其与结果的关系尚未在择期肺切除中描述。本研究旨在描述接受择期肺切除术的患者中普遍存在的术前阿片类药物使用情况，并比较术前阿片类药物暴露与无术前阿片类药物暴露患者的临床结果。
研究人员使用 IBM Watson Health MarketScan 数据库（2007 年至 2015 年）组建了接受择期肺切除术的成年患者回顾性队列。该研究比较了阿片类药物未使用患者与术前有阿片类药物使用史的患者（手术前 90 天内有>0 吗啡毫克当量处方）。使用多变量逻辑和线性回归，根据患者的社会人口统计学、合并症和手术特征进行调整，比较术后并发症、延长住院时间（>14 天）、30 天出院后急诊就诊、90 天再入院和 90 天费用的可能性。
研究确定了 14373 例患者，其中 4502 例（31.3%）在肺切除术前有阿片类药物暴露。多变量回归显示，术前使用阿片类药物的患者经历延长住院时间（优势比 [OR]，1.32；95%置信区间 [CI]，1.11 至 1.58）、30 天急诊就诊（OR，1.24；95% CI，1.01 至 1.41）和 90 天再入院（OR，1.41；95% CI，1.28 至 1.55）的可能性显著更高。术前使用阿片类药物的患者调整后的 90 天费用约高 5%（P<0.001）。
接受肺切除术的患者中有三分之一在术前使用阿片类药物，有发生不良后果和显著增加医疗保健使用的风险。他们代表了一个独特的高风险人群，需要新的、有针对性的干预措施。
