Thomas Jefferson University, Philadelphia, PA, USA.
Hand (N Y). 2022 Jul;17(4):701-705. doi: 10.1177/1558944720964967. Epub 2020 Oct 19.
Orthopedic surgical patients in general have been found to be at higher risk for developing opioid dependence in the postoperative period. However, there is conflicting evidence in the literature whether opioid exposure after hand surgery leads to prolonged use. In the absence of a nonoperative control group, it is not clear whether prolonged opioid use in hand surgical patients is related to undergoing a surgical intervention. The purpose of our study to compare opioid prescription fulfillment patterns in surgical and nonoperative patients in a hand surgery practice.
We retrospectively compared 320 patients that underwent elbow, wrist, and hand surgery procedures with 741 nonoperative patients treated by 2 hand surgeons. The Pennsylvania Drug Monitoring Program (PDMP), a mandatory statewide database, was used to evaluate the primary outcomes of filling more than one opioid prescription and filling opioid prescriptions beyond 6 months of the index surgery or clinic visit. Bivariate and multivariable logistic regression analysis was performed using the following variables: surgery, prior benzodiazepine use, and prior opioid use.
There was no difference in prior opioid use (15.2% vs 16.9%, = .51) or prior benzodiazepine (10.4% vs 8.4%, = .33) use between the nonoperative and operative groups. Patients that underwent surgery had a higher incidence of filling more than one opioid prescription (20.9% vs 8.8%, < .001). However, continued opioid use was not statistically different between nonoperative and operative patients (2.8% vs 5%, = .08). Bivariate analysis demonstrated that prior opioids (odds ratio [OR] = 12.94, < .001) and prior benzodiazepines (OR = 1.95, < .001) were significant independent risk factors for prolonged opioid use. Multivariable analysis demonstrated prior opioid use to be the only independent risk factor for prolonged opioid use (OR = 12.58, < .001).
Undergoing outpatient hand surgery do not appear to be an independent risk factor for filling opioid prescriptions beyond 6 months. Significant risk factors for prolonged opioid use include prior use of controlled substances, particularly prior opioid use.
一般来说，骨科手术患者在术后发生阿片类药物依赖的风险较高。然而，文献中关于手部手术后阿片类药物暴露是否导致长期使用存在矛盾的证据。由于缺乏非手术对照组，尚不清楚手部手术患者的阿片类药物长期使用是否与手术干预有关。本研究的目的是比较手部手术实践中手术患者和非手术患者的阿片类药物处方使用模式。
我们回顾性比较了 2 名手部外科医生治疗的 320 例肘部、腕部和手部手术患者和 741 例非手术患者。宾夕法尼亚州药物监测计划（PDMP）是一个强制性的全州数据库，用于评估主要结局，即填写超过一份阿片类药物处方和在索引手术或就诊后 6 个月以上填写阿片类药物处方。使用以下变量进行双变量和多变量逻辑回归分析：手术、先前使用苯二氮䓬类药物和先前使用阿片类药物。
非手术组和手术组在先前使用阿片类药物（15.2%对 16.9%， =.51）或先前使用苯二氮䓬类药物（10.4%对 8.4%， =.33）方面无差异。手术患者开具超过一份阿片类药物处方的发生率更高（20.9%对 8.8%， <.001）。然而，非手术组和手术组的持续阿片类药物使用在统计学上没有差异（2.8%对 5%， =.08）。双变量分析表明，先前使用阿片类药物（比值比[OR] = 12.94， <.001）和先前使用苯二氮䓬类药物（OR = 1.95， <.001）是延长阿片类药物使用的显著独立危险因素。多变量分析表明，先前使用阿片类药物是延长阿片类药物使用的唯一独立危险因素（OR = 12.58， <.001）。
门诊手部手术似乎不是 6 个月后开具阿片类药物处方的独立危险因素。延长阿片类药物使用的显著危险因素包括先前使用受控物质，特别是先前使用阿片类药物。
