阴道分娩后开具的处方类阿片类药物剂量与严重阿片类药物相关不良事件风险：一项回顾性队列研究。
Prescription Opioid Dose After Vaginal Delivery and the Risk of Serious Opioid-Related Events: A Retrospective Cohort Study.
机构信息
Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee.
出版信息
Womens Health Issues. 2021 Jul-Aug;31(4):376-383. doi: 10.1016/j.whi.2021.03.002. Epub 2021 Apr 15.
PURPOSE
Postpartum opioid use remains common among women with uncomplicated vaginal delivery and may increase the risk of serious opioid-related events. Therefore, we examined the association between the dose of the first filled opioid prescription after vaginal delivery and the subsequent risk of serious opioid-related events.
METHODS
We conducted a retrospective cohort study among women enrolled in Tennessee Medicaid with a vaginal delivery (2007-2015). We used Cox proportional hazards regression to model adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for serious opioid-related events after delivery according to the dose (morphine milligram equivalents [MME]) of the first postpartum opioid prescription, accounting for comorbidities, medication use, parity, and delivery complications. Serious opioid-related events were defined as the occurrence of persistent opioid use, a methadone or buprenorphine fill, opioid use disorder diagnosis, opioid overdose, or opioid-related death. We used filled pharmacy data to characterize the dose of the first postpartum opioid prescription filled within 4 days after delivery.
RESULTS
More than one-half of women (53.2%; n = 147,598) filled an opioid prescription within 4 days of a vaginal delivery. After accounting for baseline risk factors, filling a postpartum opioid prescription was associated with an increased risk of serious opioid-related events across all dose categories, compared with women filling none (aHR 1-99 MME, 1.52; 95% CI, 1.33-1.74; aHR 100-149 MME, 1.41; 95% CI, 1.26-1.58; aHR 150-199 MME, 1.40; 95% CI, 1.26-1.57: and aHR ≥200 MME, 1.60; 95% CI, 1.43-1.78).
CONCLUSIONS
Filling a postpartum opioid prescription after a vaginal delivery was associated with an increased risk of serious opioid-related events, regardless of dose. Prescribing guidelines should discourage the routine prescribing of opioids after vaginal delivery.
目的
产后阿片类药物的使用在阴道分娩的女性中仍然很常见，并且可能增加严重阿片类药物相关事件的风险。因此，我们研究了阴道分娩后首次开具的阿片类药物处方剂量与随后发生严重阿片类药物相关事件的风险之间的关系。
方法
我们对田纳西州医疗补助计划中接受阴道分娩的女性（2007-2015 年）进行了回顾性队列研究。我们使用 Cox 比例风险回归模型，根据产后首次阿片类药物处方的剂量（吗啡毫克当量[MME]），对分娩后发生严重阿片类药物相关事件的调整后危害比（aHR）和 95%置信区间（CI）进行建模，同时考虑了合并症、药物使用、产次和分娩并发症。严重阿片类药物相关事件定义为持续性阿片类药物使用、美沙酮或丁丙诺啡的使用、阿片类药物使用障碍诊断、阿片类药物过量或阿片类药物相关死亡。我们使用配药数据来描述产后 4 天内首次开具的阿片类药物处方的剂量。
结果
超过一半的女性（53.2%；n=147598）在阴道分娩后 4 天内开具了阿片类药物处方。在考虑了基线风险因素后，与未开具阿片类药物处方的女性相比，开具阿片类药物处方与所有剂量类别下严重阿片类药物相关事件的风险增加相关（1-99 MME 剂量的 aHR 为 1.52；95%CI，1.33-1.74；100-149 MME 剂量的 aHR 为 1.41；95%CI，1.26-1.58；150-199 MME 剂量的 aHR 为 1.40；95%CI，1.26-1.57；≥200 MME 剂量的 aHR 为 1.60；95%CI，1.43-1.78）。
结论
阴道分娩后开具阿片类药物处方与严重阿片类药物相关事件的风险增加相关，与剂量无关。处方指南应劝阻常规开具阴道分娩后阿片类药物。
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