Ogura Yoji, Gum Jeffrey L, Steele Portia, Crawford Charles H, Djurasovic Mladen, Owens R Kirk, Laratta Joseph, Brown Morgan, Daniels Christy, Dimar John R, Glassman Steven D, Carreon Leah Y
Norton Leatherman Spine Center, Louisville, KY, USA.
J Spine Surg. 2021 Mar;7(1):19-25. doi: 10.21037/jss-20-626.
With the current opioid crisis, as many as 38% of patients are still on opioids one year after elective spine surgery. Identifying drivers of in-hospital opioid consumption may decrease subsequent opioid dependence. We aimed to identify the drivers of in-hospital opioid consumption in patients undergoing 1-2-level instrumented lumbar fusions.
This is a retrospective cohort study. Electronic medical record analysts identified consecutive patients undergoing 1-2 level instrumented lumbar fusions for degenerative lumbar conditions from 2016 to 2018 from a single-center hospital administrative database. Oral, intravenous, and transdermal opioid dose administrations were converted to morphine milligram equivalents (MME). Linear regression analysis was used to determine associations between postoperative day (POD) 4 cumulative in-hospital MMEs and the patients' baseline characteristics including body mass index (BMI), race, American Society of Anesthesiologists (ASA) grade, smoking status, marital status, insurance type, zip code, number of fused levels, approach and preoperative opioid use.
A total of 1,502 patients were included. The mean cumulative MMEs at POD 4 was 251.5. Linear regression analysis yielded four drivers including younger age, preoperative opioid use, current smokers and more levels fused. There were no associations with surgical approach, zip code, ASA grade, marital status, BMI, race or insurance type.
Use of preoperative opioids and smoking are modifiable risk factors for higher in-hospital opioid consumption and can be targets for intervention prior to surgery in order to decrease in-hospital opioid use.
在当前的阿片类药物危机背景下，多达38%的患者在择期脊柱手术后一年仍在使用阿片类药物。确定住院期间阿片类药物消费的驱动因素可能会减少随后的阿片类药物依赖。我们旨在确定接受1-2节段器械辅助腰椎融合术患者住院期间阿片类药物消费的驱动因素。
这是一项回顾性队列研究。电子病历分析人员从一家单中心医院管理数据库中识别出2016年至2018年因退行性腰椎疾病接受1-2节段器械辅助腰椎融合术的连续患者。口服、静脉注射和经皮阿片类药物剂量给药均转换为吗啡毫克当量（MME）。采用线性回归分析来确定术后第4天（POD）住院期间累积MME与患者的基线特征之间的关联，这些基线特征包括体重指数（BMI）、种族、美国麻醉医师协会（ASA）分级、吸烟状况、婚姻状况、保险类型、邮政编码、融合节段数、手术入路和术前阿片类药物使用情况。
共纳入1502例患者。术后第4天的平均累积MME为251.5。线性回归分析得出四个驱动因素，包括年龄较小、术前使用阿片类药物、当前吸烟者以及融合节段更多。与手术入路、邮政编码、ASA分级、婚姻状况、BMI、种族或保险类型无关。
术前使用阿片类药物和吸烟是住院期间阿片类药物消费较高的可改变风险因素，可作为术前干预的目标，以减少住院期间阿片类药物的使用。
