From the Division of Plastic Surgery, Department of Surgery, Washington University School of Medicine; and the Section of Plastic Surgery, Department of Surgery, University of Michigan.
Plast Reconstr Surg. 2021 Mar 1;147(3):690-698. doi: 10.1097/PRS.0000000000007643.
New persistent opioid use has been quantified among adults undergoing surgery; less is known about the risk among adolescents. The authors examine new persistent opioid use in opioid-naive adolescent patients who underwent operative repair of facial fractures.
Using the IBM MarketScan Commercial Database, the authors performed a retrospective analysis of patients aged 11 to 17 years who underwent facial fracture repair between 2006 and 2015. The incidences of prolonged opioid use and potentially inappropriate opioid prescriptions were determined.
Of 4892 patients, 78.5 percent filled a prescription. Among these patients, 7.9 percent had prolonged opioid use. Significant risk factors included older age (i.e., age 15 to 17 years) (OR, 1.579; 95 percent CI, 1.173 to 2.126 compared to younger patients), multiple comorbidities (OR, 3.005; 95 percent CI, 1.193 to 7.568), mandible fracture (OR, 1.614; 95 percent CI, 1.213 to 2.146), and multiple fractures (OR, 1.542; 95 percent CI, 1.002 to 2.372). Overall, 24.1 percent received a potentially inappropriate opioid prescription. Mandible fracture repair was associated with increased risk (OR, 2.753; 95 percent CI, 2.275 to 3.331) of potentially inappropriate opioid prescription.
Nearly one in 12 adolescents met criteria for prolonged opioid use; nearly one in four received a potentially inappropriate opioid prescription. Significant risk factors included mandible fracture, older age, multiple comorbidities, and multiple fractures. Like adults, many adolescents are at high risk for potentially inappropriate opioid prescriptions and prolonged opioid use following surgical repair.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
新的持续性阿片类药物使用在接受手术的成年人中已经被量化；但在青少年中，这种风险的相关信息则较为有限。作者研究了接受手术修复面部骨折的阿片类药物初治青少年患者中新的持续性阿片类药物使用情况。
作者使用 IBM MarketScan 商业数据库，对 2006 年至 2015 年间接受面部骨折修复的 11 至 17 岁患者进行了回顾性分析。确定了延长使用阿片类药物和潜在不适当阿片类药物处方的发生率。
在 4892 名患者中，78.5%的患者开具了处方。在这些患者中，7.9%的患者存在延长使用阿片类药物的情况。显著的危险因素包括年龄较大（即 15 至 17 岁）（比值比，1.579；95%置信区间，1.173 至 2.126，与年轻患者相比）、多种合并症（比值比，3.005；95%置信区间，1.193 至 7.568）、下颌骨骨折（比值比，1.614；95%置信区间，1.213 至 2.146）和多处骨折（比值比，1.542；95%置信区间，1.002 至 2.372）。总体而言，24.1%的患者接受了潜在不适当的阿片类药物处方。下颌骨骨折修复与潜在不适当阿片类药物处方风险增加相关（比值比，2.753；95%置信区间，2.275 至 3.331）。
近 12%的青少年符合延长使用阿片类药物的标准；近四分之一的青少年接受了潜在不适当的阿片类药物处方。显著的危险因素包括下颌骨骨折、年龄较大、多种合并症和多处骨折。与成年人一样，许多青少年在接受手术修复后存在潜在不适当的阿片类药物处方和延长使用阿片类药物的高风险。
临床问题/证据水平：风险，III 级。
