手术当天使用加巴喷丁类药物和延长阿片类药物使用：一项使用电子健康记录的 Medicare 患者回顾性队列研究。
Day-of-Surgery Gabapentinoids and Prolonged Opioid Use: A Retrospective Cohort Study of Medicare Patients Using Electronic Health Records.
机构信息
From the Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
出版信息
Anesth Analg. 2021 Nov 1;133(5):1119-1128. doi: 10.1213/ANE.0000000000005656.
BACKGROUND
While preoperative gabapentinoids are commonly used in surgical multimodal analgesia protocols, little is known regarding the effects this therapy has on prolonged postsurgical opioid use. In this observational study, we used data from a large integrated health care system to estimate the association between preoperative day-of-surgery gabapentinoids and the risk of prolonged postsurgical opioid use.
METHODS
We identified adults age ≥65 years undergoing major therapeutic surgical procedures from a large integrated health care system from 2016 to 2019. Exposure to preoperative gabapentinoids on the day of surgery was measured using inpatient medication administration records, and the outcome of prolonged opioid use was measured using outpatient medication orders. We used stabilized inverse probability of treatment-weighted log-binomial regression to estimate risk ratios and 95% confidence intervals (CIs) of prolonged opioid use, comparing patients who received preoperative gabapentinoids to those who did not and adjusting for relevant clinical factors. The main analysis was conducted in the overall surgical population, and a secondary analysis was conducted among procedures where at least 30% of all patients received a preoperative gabapentinoid.
RESULTS
Overall, 13,958 surgical patients met inclusion criteria, of whom 21.0% received preoperative gabapentinoids. The observed 90-day risk of prolonged opioid use following surgery was 0.91% (95% CI, 0.77-1.08). Preoperative gabapentinoid administration was not associated with a reduced risk of prolonged opioid use in the main analysis conducted in a broad surgical population (adjusted risk ratio [adjRR], 1.19 [95% CI, 0.67-2.12]) or in the secondary analysis conducted in patients undergoing colorectal resection, hip arthroplasty, knee arthroplasty, or hysterectomy (adjRR, 1.01 [95% CI, 0.30-3.33]).
CONCLUSIONS
In a large integrated health system, we did not find evidence that preoperative gabapentinoids were associated with reduced risk of prolonged opioid use in patients undergoing a broad range of surgeries.
背景
尽管术前加巴喷丁类药物常用于手术多模式镇痛方案，但对于这种治疗方法对术后长期使用阿片类药物的影响知之甚少。在这项观察性研究中，我们使用来自大型综合医疗保健系统的数据来估计术前手术当天加巴喷丁类药物与术后长期使用阿片类药物风险之间的关联。
方法
我们从 2016 年至 2019 年期间从大型综合医疗保健系统中确定了年龄≥65 岁接受重大治疗性手术的成年人。使用住院药物管理记录来衡量手术当天接受术前加巴喷丁类药物的情况，使用门诊药物医嘱来衡量延长使用阿片类药物的情况。我们使用稳定的逆概率治疗加权对数二项式回归来估计延长使用阿片类药物的风险比和 95%置信区间 (CI)，将接受术前加巴喷丁类药物的患者与未接受的患者进行比较，并调整相关临床因素。主要分析在整个手术人群中进行，次要分析在至少 30%的患者接受术前加巴喷丁类药物的手术中进行。
结果
总体而言，有 13958 名手术患者符合纳入标准，其中 21.0%接受了术前加巴喷丁类药物。术后 90 天延长使用阿片类药物的观察风险为 0.91%（95%CI，0.77-1.08）。在广泛的手术人群中进行的主要分析中，术前加巴喷丁类药物的使用与延长使用阿片类药物的风险降低无关（调整后的风险比 [adjRR]，1.19 [95%CI，0.67-2.12]）或在接受结直肠切除术、髋关节置换术、膝关节置换术或子宫切除术的患者中进行的次要分析中（adjRR，1.01 [95%CI，0.30-3.33]）。
结论
在大型综合医疗系统中，我们没有发现证据表明术前加巴喷丁类药物与接受广泛手术的患者延长使用阿片类药物的风险降低有关。
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