Larsson Viktoria, Nordenson Cecilia, Karling Pontus
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
Scand J Pain. 2021 Apr 12;21(3):569-576. doi: 10.1515/sjpain-2020-0150. Print 2021 Jul 27.
Opioids are commonly prescribed post-surgery. We investigated the proportion of patients who were prescribed any opioids 6-12 months after two common surgeries - laparoscopic cholecystectomy and gastric by-pass (GBP) surgery. A secondary aim was to examine risk factors prior to surgery associated with the prescription of any opioids after surgery.
We performed a retrospective observational study on data from medical records from patients who underwent cholecystectomy (n=297) or GBP (n=93) in 2018 in the Region of Västerbotten, Sweden. Data on prescriptions for opioids and other drugs were collected from the patients` medical records.
There were 109 patients (28%) who were prescribed opioids after discharge from surgery but only 20 patients (5%) who still received opioid prescriptions 6-12 months after surgery. All 20 of these patients had also been prescribed opioids within three months before surgery, most commonly for back and joint pain. Only 1 out of 56 patients who were prescribed opioids preoperatively due to gallbladder pain still received prescriptions for opioids 6-12 months after surgery. Although opioid use in the early postoperative period was more common among patients who underwent cholecystectomy, the patients who underwent GBP were more prone to be "long-term" users of opioids. In the patients who were prescribed opioids within three months prior to surgery, 8 out of 13 patients who underwent GBP and 12 of the 96 patients who underwent cholecystectomy were still prescribed opioids 6-12 months after surgery (OR 11.2; 95% CI 3.1-39.9, p=0,0002). Affective disorders were common among "long-term" users of opioids and prior benzodiazepine and amitriptyline use were significantly associated with "long-term" opioid use.
The proportion of patients that used opioids 6-12 months after cholecystectomy or GBP was low. Patients with preoperative opioid-use experienced a significantly higher risk of "long-term" opioid use when undergoing GBP compared to cholecystectomy. The indication for being prescribed opioids in the "long-term" were mostly unrelated to surgery. No patient who was naïve to opioids prior surgery was prescribed opioids 6-12 months after surgery. Although opioids are commonly prescribed in the preoperative and in the early postoperative period to patients with gallbladder disease, there is a low risk that these prescriptions will lead to long-term opioid use. The reasons for being prescribed opioids in the long-term are often due to causes not related to surgery.
阿片类药物常用于术后处方。我们调查了两种常见手术后6至12个月开具任何阿片类药物处方的患者比例，这两种手术分别是腹腔镜胆囊切除术和胃旁路（GBP）手术。次要目的是检查术前与术后开具任何阿片类药物处方相关的危险因素。
我们对2018年在瑞典韦斯特博滕地区接受胆囊切除术（n = 297）或GBP手术（n = 93）的患者的病历数据进行了回顾性观察研究。从患者病历中收集阿片类药物和其他药物的处方数据。
有109名患者（28%）在手术后出院时开具了阿片类药物处方，但只有20名患者（5%）在术后6至12个月仍接受阿片类药物处方。所有这20名患者在手术前三个月内也开具了阿片类药物处方，最常见的是用于背部和关节疼痛。术前因胆囊疼痛开具阿片类药物处方的56名患者中，只有1名在术后6至12个月仍接受阿片类药物处方。虽然术后早期使用阿片类药物在接受胆囊切除术的患者中更为常见，但接受GBP手术的患者更容易成为阿片类药物的“长期”使用者。在手术前三个月内开具阿片类药物处方的患者中，接受GBP手术的13名患者中有8名，接受胆囊切除术的96名患者中有12名在术后6至12个月仍开具阿片类药物处方（比值比11.2；95%置信区间3.1 - 39.9，p = 0.0002）。情感障碍在阿片类药物“长期”使用者中很常见，先前使用苯二氮卓类药物和阿米替林与“长期”阿片类药物使用显著相关。
胆囊切除术或GBP手术后6至12个月使用阿片类药物的患者比例较低。与胆囊切除术相比，术前使用阿片类药物的患者在接受GBP手术时“长期”使用阿片类药物的风险显著更高。“长期”开具阿片类药物处方的指征大多与手术无关。术前未使用过阿片类药物的患者在术后6至12个月均未开具阿片类药物处方。虽然胆囊疾病患者在术前和术后早期通常会开具阿片类药物处方，但这些处方导致长期使用阿片类药物的风险较低。长期开具阿片类药物处方的原因通常与手术无关。
