Department of Obstetrics and Gynecology, Mount Sinai Hospital (Drs. Chan and Murji).
ICES Western, London (Ms. Le, Ms. Lam, and Dr. Shariff), Ontario, Canada.
J Minim Invasive Gynecol. 2021 Jul;28(7):1325-1333.e3. doi: 10.1016/j.jmig.2021.01.011. Epub 2021 Jan 24.
To describe the opioid prescribing practices in opioid-naive women undergoing elective gynecologic surgery for benign indications and identify risk factors associated with increased perioperative opioid use. We also explored factors associated with new persistent opioid use in women with perioperative opioid use.
Retrospective, population-based cohort study.
We used linked administrative data from a government-administered single-payer provincial healthcare system in Canada. This study was undertaken at ICES, a not-for-profit research institute in Ontario, Canada.
We followed opioid-naive adult women who underwent benign elective gynecologic surgery between 2013 and 2018.
None.
The primary outcome was perioperative opioid use defined as ≥1 opioid prescription from 30 days before to 14 days after surgery. New persistent opioid use after gynecologic surgery was defined as having filled 1 or more opioid prescriptions between 91 days and 180 days postoperatively. Multivariable log-linear regression analyses were employed to adjust for clinical and demographic data. Of the 132 506 patients included in our cohort, most (74.3%) underwent minor gynecologic procedures. Perioperative opioid use was documented in 27 763 (21.0%) patients, and there was a significant decreasing trend (p <.001) in the proportion of patients with perioperative opioid use from 21.8% in 2013 to 18.5% in 2018. Factors associated with increased perioperative opioid use included younger age; higher income quintile; urban dwellers; and diagnosis of infertility, endometriosis, or adnexal mass. Perioperative opioid use was an independent risk factor for persistent use (adjusted relative risk 1.40; 95% confidence interval, 1.13-1.72) and for every 65 patients prescribed opioids associated with gynecologic surgery, one developed new persistent opioid use. The highest risk factor for developing persistent use was filling a high-dose opioid prescription (adjusted relative risk 2.33; 95% confidence interval, 1.83-2.96).
One in 5 women who undergo a gynecologic procedure has a new exposure to opioids. For every 65 patients who fill an opioid prescription after their gynecologic surgery, one will experience prolonged opioid use.
描述接受择期妇科良性手术的阿片类药物初治女性的阿片类药物处方实践，并确定与围手术期阿片类药物使用增加相关的风险因素。我们还探讨了与围手术期使用阿片类药物的女性中新出现持续性阿片类药物使用相关的因素。
回顾性、基于人群的队列研究。
我们使用来自加拿大政府管理的单一支付者省级医疗保健系统的链接行政数据。这项研究是在加拿大安大略省的非营利性研究所 ICES 进行的。
我们随访了 2013 年至 2018 年间接受良性择期妇科手术的阿片类药物初治成年女性。
无。
主要结局是围手术期阿片类药物使用，定义为手术前 30 天至手术后 14 天内至少开具 1 份阿片类药物处方。妇科手术后出现新的持续性阿片类药物使用定义为在术后 91 天至 180 天内至少开具 1 份阿片类药物处方。多变量对数线性回归分析用于调整临床和人口统计学数据。在我们的队列中，纳入的 132506 例患者中，大多数（74.3%）接受了较小的妇科手术。27763 例（21.0%）患者记录了围手术期阿片类药物使用，且从 2013 年的 21.8%到 2018 年的 18.5%，围手术期阿片类药物使用的比例呈显著下降趋势（p<.001）。与围手术期阿片类药物使用增加相关的因素包括年龄较小；收入较高五分位数；城市居民；以及不孕、子宫内膜异位症或附件包块的诊断。围手术期阿片类药物使用是持续性使用的独立危险因素（调整后的相对风险 1.40；95%置信区间，1.13-1.72），每 65 例接受与妇科手术相关的阿片类药物处方的患者中，就有 1 例出现新的持续性阿片类药物使用。发展为持续性使用的最高危险因素是开具高剂量阿片类药物处方（调整后的相对风险 2.33；95%置信区间，1.83-2.96）。
每 5 例接受妇科手术的女性中就有 1 例新接触阿片类药物。每 65 例接受妇科手术后开阿片类药物处方的患者中，就有 1 例会出现持续性阿片类药物使用。
