Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Pharmacoepidemiol Drug Saf. 2021 Mar;30(3):390-394. doi: 10.1002/pds.5187. Epub 2021 Jan 5.
To evaluate recent trends in inpatient postoperative utilization of opioid and non-opioid analgesics in US hospitals.
Using Premier Research database (October 2007-September 2017), we identified adults who were hospitalized for inpatient surgical procedures (N = 6 068 133). For each month, we calculated proportion of patients admitted that month who were administered (1) opioids, (2) acetaminophen, (3) non-steroidal anti-inflammatory drugs (NSADs), and (4) gabapentinoids (gabapentin or pregabalin) during the postoperative period, defined as inpatient postoperative days 1-7, unless discharged earlier. For patients administered opioids, we estimated total and average daily postoperative opioid dose in morphine milligram equivalents (MMEs). Monthly measures were standardized to the distribution of surgeries and the length of postoperative stay within each surgery during the last year of available data.
Overall, 90.8% of patients were administered opioids postoperatively; mean total postoperative dose was 304 MMEs (median 130). Both the frequency and the amount of opioids administered remained stable over 2007-2017. Postoperative use of acetaminophen increased from mean standardized monthly prevalence of 78% in 2007-2008 to 85% in 2017, while the use of NSAIDs remained stable at a standardized mean of 37%. The use of gabapentinoids increased from below 10% in 2007-2008 to the mean standardized monthly prevalence of 23% in 2017.
Despite growing awareness of risks associated with postoperative opioid use, we observed no change in postoperative utilization of opioids in US hospitals. Increasing the use of non-opioid pain management approaches could constitute an important target in our efforts to curtail US opioid epidemic.
评估美国医院住院患者术后使用阿片类药物和非阿片类药物镇痛的最新趋势。
使用 Premier Research 数据库（2007 年 10 月至 2017 年 9 月），我们确定了因住院手术而住院的成年人（N=6068133）。对于每个月，我们计算了该月接受以下治疗的患者比例：（1）阿片类药物；（2）对乙酰氨基酚；（3）非甾体抗炎药（NSAIDs）；和（4）加巴喷丁类药物（加巴喷丁或普瑞巴林），定义为术后住院期间第 1-7 天，除非提前出院。对于接受阿片类药物治疗的患者，我们估计了术后吗啡毫克当量（MME）的总剂量和平均日剂量。每月的测量值根据可用数据最后一年中每个手术的手术分布和术后住院时间进行标准化。
总体而言，90.8%的患者术后接受了阿片类药物治疗；平均总术后剂量为 304 MME（中位数 130）。2007-2017 年期间，阿片类药物的使用频率和剂量均保持稳定。术后对乙酰氨基酚的使用从 2007-2008 年的标准化每月流行率 78%增加到 2017 年的 85%，而 NSAIDs 的使用则保持在标准化均值 37%的稳定水平。加巴喷丁类药物的使用从 2007-2008 年的不到 10%增加到 2017 年的标准化每月流行率 23%。
尽管人们越来越意识到术后使用阿片类药物相关的风险，但我们观察到美国医院术后阿片类药物使用并未发生变化。增加非阿片类药物疼痛管理方法的使用可能是我们遏制美国阿片类药物流行的努力中的一个重要目标。
