Cardiovascular Division (T.M.M., G.S.G., M.C.H., J.S.A., P.S., R.D.S., G.E.S., R.D., S.N., S.D., D.J.C., A.E.E., F.E.M., D.S.F.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
Division of Cardiovascular Surgery (C.R.B.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
Circulation. 2021 Nov 16;144(20):1590-1597. doi: 10.1161/CIRCULATIONAHA.121.055524. Epub 2021 Nov 15.
Prescription opioids are a major contributor to the ongoing epidemic of persistent opioid use (POU). The incidence of POU among opioid-naïve patients after cardiac implantable electronic device (CIED) procedures is unknown.
This retrospective cohort study used data from a national administrative claims database from 2004 to 2018 of patients undergoing CIED procedures. Adult patients were included if they were opioid-naïve during the 180-day period before the procedure and did not undergo another procedure with anesthesia in the next 180 days. POU was defined by filling an additional opioid prescription >30 days after the CIED procedure.
Of the 143 400 patients who met the inclusion criteria, 15 316 (11%) filled an opioid prescription within 14 days of surgery. Among these patients, POU occurred in 1901 (12.4%) patients 30 to 180 days after surgery. The likelihood of developing POU was increased for patients who had a history of drug abuse (odds ratio, 1.52; =0.005), preoperative muscle relaxant (odds ratio, 1.52; <0.001) or benzodiazepine (odds ratio, 1.23; =0.001) use, or opioid use in the previous 5 years (OR, 1.76; <0.0001). POU did not differ after subcutaneous implantable cardioverter defibrillator or other CIED procedures (11.1 versus 12.4%; =0.5). In a sensitivity analysis excluding high-risk patients who were discharged to a facility or who had a history of drug abuse or previous opioid, benzodiazepine, or muscle relaxant use, 8.9% of the remaining cohort had POU. Patients prescribed >135 mg of oral morphine equivalents had a significantly increased risk of POU.
POU is common after CIED procedures, and 12% of patients continued to use opioids >30 days after surgery. Higher initially prescribed oral morphine equivalent doses were associated with developing POU.
处方类阿片药物是持续性阿片类药物使用（POU）这一持续流行态势的主要成因。心脏植入式电子设备（CIED）术后，阿片类药物初治患者发生 POU 的发生率尚不明确。
本回顾性队列研究使用了来自 2004 年至 2018 年全国行政索赔数据库的数据，纳入了行 CIED 手术的成年患者。如果患者在手术前的 180 天内没有使用过阿片类药物，且在接下来的 180 天内没有接受过其他需要麻醉的手术，则认为其为阿片类药物初治患者。POU 定义为在 CIED 手术后 30 至 180 天内再次开具阿片类药物处方。
在符合纳入标准的 143400 名患者中，有 15316 名（11%）患者在术后 14 天内开具了阿片类药物处方。其中，1901 名（12.4%）患者在术后 30 至 180 天内发生了 POU。与无药物滥用史（比值比[OR]，1.52；=0.005）、术前未使用肌松剂（OR，1.52；<0.001）或苯二氮䓬类药物（OR，1.23；=0.001）或在过去 5 年内使用过阿片类药物的患者相比，有药物滥用史、术前使用肌松剂或苯二氮䓬类药物、或在过去 5 年内使用过阿片类药物的患者发生 POU 的可能性更高。皮下植入式除颤器或其他 CIED 手术后 POU 发生率并无差异（11.1%比 12.4%；=0.5）。在排除出院至医疗机构或有药物滥用史或既往阿片类药物、苯二氮䓬类药物或肌松剂使用史的高危患者的敏感性分析中，剩余队列中仍有 8.9%的患者发生了 POU。初始处方口服吗啡等效剂量>135mg 的患者发生 POU 的风险显著增加。
CIED 术后 POU 很常见，有 12%的患者在术后 30 天以上仍继续使用阿片类药物。较高的初始口服吗啡等效剂量与 POU 的发生有关。
