Department of Neurosurgery, Duke University, 3480 Wake Forest Rd, Raleigh, NC 27609, USA.
Michigan Opioid Prescribing Engagement Network (M-OPEN), 2800 Plymouth Rd, North Campus Research Complex (NCRC), Bldg 16, Ann Arbor, MI 48109, USA.
Spine J. 2021 May;21(5):772-778. doi: 10.1016/j.spinee.2021.01.016. Epub 2021 Jan 16.
Best practices in opioid prescribing after elective surgery have been developed for most surgical subspecialties, including spine. However, some percentage of patients will become chronic users.
This study aimed to determine the relationship between the size of initial opioid prescription after surgery for degenerative spinal disease and the likelihood of refills.
STUDY DESIGN/SETTING: Retrospective case-control study.
Opioid-naïve patients aged 18 to 64 undergoing elective spinal procedures (anterior cervical discectomy and fusion, posterior cervical fusion, lumbar decompression, and lumbar fusion) from 2010 to 2015 filling an initial perioperative prescription using insurance claims from Truven Health MarketScan (n=25,329).
Functional measure: health-care utilization. Primary outcome was occurrence of an opioid refill within 30 postoperative days.
We used logistic regression to examine the probability of an additional refill by initial opioid prescription strength, adjusting for patient factors.
About 26.3% of opioid-naïve patients obtained refills of their opioid prescriptions within 30 days of surgery. The likelihood of obtaining a refill was unchanged with the size of the initial perioperative prescription across procedure categories. Patient factors associated with increased likelihood of refills included age 30 to 39 years (odds ratio [OR] 1.137, p=.007, 95% confidence interval [CI] 1.072-1.249), female gender (OR 1.137, p<.001, 95% CI 1.072-1.207), anxiety disorder (OR 1.141, p=.017, 95% CI 1.024-1.272), mood disorder (OR 1.109 p=.049, 95% CI 1.000-1.229), and history of alcohol/substance abuse (OR 1.445 p=.006, 95% CI 1.110-1.880).
For opioid-naïve patients, surgeons can prescribe lower amounts of opioids after elective surgery for degenerative spinal disease without concern of increased need for refills.
已为大多数外科亚专科（包括脊柱）制定了择期手术后阿片类药物处方的最佳实践。然而，仍有一定比例的患者将成为慢性使用者。
本研究旨在确定术后退行性脊柱疾病初始阿片类药物处方的大小与再开处方的可能性之间的关系。
研究设计/设置：回顾性病例对照研究。
2010 年至 2015 年期间，使用 Truven Health MarketScan 的保险索赔，对接受择期脊柱手术（前路颈椎间盘切除术和融合术、后路颈椎融合术、腰椎减压术和腰椎融合术）的年龄在 18 至 64 岁之间且无阿片类药物使用史的患者（n=25329）进行初始围手术期处方用药。
功能测量：医疗保健利用。主要结果是术后 30 天内是否发生阿片类药物再开处方。
我们使用逻辑回归来检查初始阿片类药物处方强度与额外再开处方的可能性之间的关系，同时调整患者因素。
约 26.3%的无阿片类药物使用史的患者在手术 30 天内获得了阿片类药物处方的再开。在不同手术类型中，初始围手术期处方的大小与获得再开处方的可能性无关。与再开处方可能性增加相关的患者因素包括 30 至 39 岁（优势比[OR]1.137，p=.007，95%置信区间[CI]1.072-1.249）、女性（OR 1.137，p<.001，95%CI 1.072-1.207）、焦虑障碍（OR 1.141，p=.017，95%CI 1.024-1.272）、心境障碍（OR 1.109，p=.049，95%CI 1.000-1.229）和酒精/物质滥用史（OR 1.445，p=.006，95%CI 1.110-1.880）。
对于无阿片类药物使用史的患者，外科医生可以在择期退行性脊柱疾病手术后开具较低剂量的阿片类药物，而不必担心增加再开处方的需求。
