Holmberg Siril T, Fredheim Olav M S, Skurtveit Svetlana, Salvesen Øyvind O, Nygaard Øystein P, Gulati Agnete M, Solberg Tore K, Gulati Sasha
Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
Depart-Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway.
Spine (Phila Pa 1976). 2022 Apr 15;47(8):607-614. doi: 10.1097/BRS.0000000000004275. Epub 2021 Nov 18.
Prospective pharmacoepidemiological study.
To investigate the use of prescription opioids 2 years following degenerative lumbar spine surgery.
There are limited data providing details to evaluate patterns of opioid use. The number of patients is often limited and data on opioid use following some of the most common surgical procedures are lacking.
Data from the Norwegian Registry for Spine Surgery and the Norwegian Prescription Database were linked on an individual level. The primary outcome measure was persistent opioid use the second year after surgery. Functional disabilitywas measured with the Oswestry disability index (ODI). Study participants were operated between 2007 and 2017.
Among 32,886 study participants, 2754 (8.4%) met criteria for persistent opioid use the second year after surgery. Among persistent opioid users in the second year after surgery, 64% met the criteria for persistent opioid use the year preceding surgery. Persistent opioid use the year preceding surgery (odds ratio [OR] 31.10, 95% confidence interval [CI] 26.9-36.0, P = 0.001), use of high doses of benzodiazepines (OR 1.62, 95% CI 1.30-2.04, P = 0.001), and use of high doses of z-hypnotics (OR 1.90, 95% CI 1.58-2.22, P = 0.001) the year before surgery were associated with increased risk of persistent opioid use the second year after surgery. A higher ODI score at 1 year was observed in persistent opioid users compared with non-persistent users (41.5 vs. 18.8 points) and there was a significant difference in ODI change (-13.7 points). Patients with persistent opioid use in the year preceding surgery were less likely to achieve a minimal clinically important ODI change at 1 year compared with non-persistent users (37.7% vs. 52.6%, P = 0.001).
Patients with or at risk of developing persistent opioid should be identified and provided counseling and support to taper off opioid treatment.Level of Evidence: 2.
前瞻性药物流行病学研究。
调查退行性腰椎手术后2年处方阿片类药物的使用情况。
提供详细信息以评估阿片类药物使用模式的数据有限。患者数量通常有限，并且缺乏一些最常见外科手术后阿片类药物使用的数据。
挪威脊柱外科登记处和挪威处方数据库的数据在个体层面上进行了关联。主要结局指标是术后第二年持续使用阿片类药物。使用奥斯威斯利功能障碍指数（ODI）测量功能障碍。研究参与者在2007年至2017年期间接受手术。
在32886名研究参与者中，2754人（8.4%）在术后第二年符合持续使用阿片类药物的标准。在术后第二年持续使用阿片类药物的人群中，64%在手术前一年符合持续使用阿片类药物的标准。手术前一年持续使用阿片类药物（比值比[OR]31.10，95%置信区间[CI]26.9 - 36.0，P = 0.001）、使用高剂量苯二氮䓬类药物（OR 1.62，95%CI 1.30 - 2.04，P = 0.001）以及手术前一年使用高剂量Z类催眠药（OR 1.90，95%CI 1.58 - 2.22，P = 0.001）与术后第二年持续使用阿片类药物风险增加相关。与非持续使用者相比，持续使用阿片类药物者在1年时的ODI评分更高（41.5分对18.8分），且ODI变化存在显著差异（-13.7分）。与非持续使用者相比，手术前一年持续使用阿片类药物的患者在1年时达到最小临床重要ODI变化的可能性更小（37.7%对52.6%，P = 0.001）。
应识别有持续使用阿片类药物或有发展为持续使用阿片类药物风险的患者，并为其提供咨询和支持以逐渐减少阿片类药物治疗。证据级别：2级。
