Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA.
Department of Otolaryngology-Head and Neck Surgery, Naval Hospital Jacksonville, Jacksonville, FL 32214, USA.
Mil Med. 2022 Aug 25;187(9-10):e1143-e1147. doi: 10.1093/milmed/usab127.
The purpose of this study was to determine if short-term, high-quantity opioid use following adult tonsillectomy in active duty military members results in opioid misuse, using a proxy measure of referrals to substance abuse rehabilitation programs.
An Institutional Review Board-approved retrospective chart review was performed of 741 active duty patients who underwent tonsillectomy between 2012 and 2017. Data collection included preoperative medications within 60 days of surgery, all postoperative opioid prescriptions up to 12 months following surgery, and referrals to substance abuse rehabilitation within a year of surgery.
Out of 741 patients, 658 met inclusion criteria. Fifty-one percent were women and the average age was 26 years. Fifty-nine percent of patients received 5 mg/325 mg oxycodone/acetaminophen as their initial postoperative pain medication. The average number of opioid tablets prescribed was 70 ± 18. Ninety three percent of patients received at least 60 tabs. The refill rate within 30 days of tonsillectomy was 38.6%. In the year following surgery, 25.4% of patients received additional doses of outpatient opioids for other indications. Nineteen patients (2.9%) were referred for substance abuse treatment within 1 year of tonsillectomy: seventeen for alcohol abuse, one for marijuana, and one for alcohol/marijuana. There were no referrals for opiate misuse or abuse.
Short-term, high-quantity opioid treatment of post-tonsillectomy pain in active duty adults does not result in long-term opioid misuse, as measured by substance abuse treatment program referrals within a year after surgery. This finding supports the appropriateness of adequate short-term narcotic medication treatment. The long-term readiness of these patients appears unaffected by long-term opioid misuse or abuse. Even with this finding, there is an institutional shift to multi-modality pain management and appropriate opioid reduction to further mitigate the risk of opioid misuse. Extrapolation of these findings to all adult tonsillectomy patients should be done with caution, as there are several protective factors in the active duty population such as stable full-time employment with mandatory random drug screening.
本研究旨在通过评估接受扁桃体切除术的现役军人是否因滥用阿片类药物而接受物质滥用康复计划转诊，来确定术后短期大剂量使用阿片类药物是否会导致阿片类药物滥用。
对 2012 年至 2017 年间接受扁桃体切除术的 741 名现役军人进行了机构审查委员会批准的回顾性图表审查。数据收集包括手术前 60 天内的术前用药、手术后 12 个月内的所有术后阿片类药物处方以及手术后一年内接受物质滥用康复的转诊情况。
741 名患者中，658 名符合纳入标准。51%为女性，平均年龄为 26 岁。59%的患者术后初始疼痛治疗使用 5mg/325mg 羟考酮/对乙酰氨基酚。开具的阿片类药物片剂平均数量为 70±18 片。93%的患者至少接受了 60 片。扁桃体切除术后 30 天内的再配药率为 38.6%。手术后一年，25.4%的患者因其他原因接受了额外的门诊阿片类药物剂量。19 名患者（2.9%）在扁桃体切除术后 1 年内因物质滥用接受了治疗：17 名因酒精滥用，1 名因大麻，1 名因酒精/大麻。没有因阿片类药物滥用或误用而转介。
在现役成年人接受扁桃体切除术后，短期大剂量使用阿片类药物治疗疼痛并不会导致术后 1 年内出现长期阿片类药物滥用，这可以通过术后一年内接受物质滥用治疗计划转诊来衡量。这一发现支持适当使用短期阿片类药物治疗。这些患者的长期准备状态似乎并未受到长期阿片类药物滥用或误用的影响。尽管有这一发现，机构仍在向多模式疼痛管理和适当减少阿片类药物的方向转变，以进一步降低阿片类药物滥用的风险。由于现役人群中有稳定的全职工作和强制性随机药物筛查等多种保护因素，因此，应谨慎将这些发现外推至所有接受扁桃体切除术的成年患者。
