Department of Surgery, Michigan Medicine, Ann Arbor, Michigan.
Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, Michigan.
Ann Surg. 2022 Dec 1;276(6):e1076-e1082. doi: 10.1097/SLA.0000000000004965. Epub 2021 Jun 4.
To compare outcomes after surgery between patients who were not prescribed opioids and patients who were prescribed opioids.
Postoperative opioid prescriptions carry significant risks. Understanding outcomes among patients who receive no opioids after surgery may inform efforts to reduce these risks.
We performed a retrospective study of adult patients who underwent surgery between January 1, 2019 and October 31, 2019. The primary outcome was the composite incidence of an emergency department visit, readmission, or reoperation within 30 days of surgery. Secondary outcomes were postoperative pain, satisfaction, quality of life, and regret collected via postoperative survey. A multilevel, mixed-effects logistic regression was performed to evaluate differences between groups.
In a cohort of 22,345 patients, mean age (standard deviation) was 52.1 (16.5) years and 13,269 (59.4%) patients were female. About 3175 (14.2%) patients were not prescribed opioids, of whom 422 (13.3%) met the composite adverse event endpoint compared to 2255 (11.8%) of patients not prescribed opioids ( P = 0.015). Patients not prescribed opioids had a similar probability of adverse events {11.7% [95% confidence interval (CI) 10.2%-13.2%] vs 11.9% (95% CI 10.6%-13.3%]}. Among 12,872 survey respondents, patients who were not prescribed an opioid had a similar rate of high satisfaction [81.7% (95% CI 77.3%-86.1%) vs 81.7% (95% CI 77.7%- 85.7%)] and no regret [(93.0% (95% CI 90.8%-95.2%) vs 92.6% (95% CI 90.4%-94.7%)].
Patients who were not prescribed opioids after surgery had similar clinical and patient-reported outcomes as patients who were prescribed opioids. This suggests that minimizing opioids as part of routine postoperative care is unlikely to adversely affect patients.
比较术后未开具阿片类药物处方和开具阿片类药物处方患者的手术治疗效果。
术后开具阿片类药物处方存在显著风险。了解术后不使用阿片类药物的患者的结局可能有助于减少这些风险。
我们对 2019 年 1 月 1 日至 2019 年 10 月 31 日期间接受手术的成年患者进行了回顾性研究。主要结局是术后 30 天内急诊就诊、再入院或再次手术的复合发生率。次要结局是通过术后调查收集的术后疼痛、满意度、生活质量和后悔感。采用多级混合效应逻辑回归评估组间差异。
在 22345 例患者队列中，平均年龄（标准差）为 52.1（16.5）岁，13269 例（59.4%）为女性。约 3175 例（14.2%）患者未开具阿片类药物处方，其中 422 例（13.3%）符合复合不良事件终点，而未开具阿片类药物处方的患者为 2255 例（11.8%）（P=0.015）。未开具阿片类药物处方的患者发生不良事件的概率相似{11.7%[95%置信区间（CI）10.2%-13.2%] vs 11.9%（95% CI 10.6%-13.3%）}。在 12872 名接受调查的患者中，未开具阿片类药物处方的患者满意度相似[81.7%（95% CI 77.3%-86.1%）vs 81.7%（95% CI 77.7%-85.7%）]，后悔率也相似[93.0%（95% CI 90.8%-95.2%）vs 92.6%（95% CI 90.4%-94.7%）]。
术后未开具阿片类药物处方的患者与开具阿片类药物处方的患者的临床和患者报告结局相似。这表明，将阿片类药物作为常规术后护理的一部分最小化不太可能对患者产生不利影响。
