Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.
Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE, 68198-3280, USA.
Surg Endosc. 2022 Nov;36(11):8430-8440. doi: 10.1007/s00464-022-09123-y. Epub 2022 Feb 28.
It is unknown if opioid naïve patients who undergo minimally invasive, benign foregut operations are at risk for progressing to persistent postoperative opioid use. The purpose of our study was to determine if opioid naïve patients who undergo minimally invasive, benign foregut operations progress to persistent postoperative opioid use and to identify any patient- and surgery-specific factors associated with persistent postoperative opioid use.
Opioid-naïve, adult patients who underwent laparoscopic fundoplication, hiatal hernia repair, or Heller myotomy from 2010 to 2018 were identified within the IBM® MarketScan® Commercial Claims and Encounters Database. Daily drug logs of the preoperative and postoperative period were evaluated to assess for changes in drug use patters. The primary outcome of interest was persistent postoperative opioid use, defined as at least 33% of the proportion of days covered by opioid prescriptions at 365-day follow-up. Patient demographic information and clinical risk factors for persistent postoperative opioid use at 365 days postoperatively were estimated using log-binomial regression.
A total of 17,530 patients met inclusion criteria; 6895 underwent fundoplication, 9235 underwent hiatal hernia repair, and 1400 underwent Heller myotomy. 9652 patients had at least one opioid prescription filled in the perioperative period. Sixty-five patients (0.4%) were found to have persistent postoperative opioid use at 365 days postoperatively. Lower Charlson comorbidity index scores and a history of mental illness or substance use disorder had a statistically but not clinically significant protective effect on the risk of persistent postoperative opioid use at 365 days postoperatively.
Only half of opioid naïve patients undergoing minimally invasive, benign foregut operations filled an opioid prescription postoperatively. The risk of progression to persistent postoperative opioid use was less than 1%. These findings support the current guidelines that limit the number of opioid pills prescribed following general surgery operations.
接受微创、良性上消化道手术的阿片类药物初治患者是否有进展为持续性术后阿片类药物使用的风险尚不清楚。我们研究的目的是确定接受微创、良性上消化道手术的阿片类药物初治患者是否进展为持续性术后阿片类药物使用，并确定与持续性术后阿片类药物使用相关的任何患者和手术特定因素。
从 IBM® MarketScan®商业索赔和就诊数据库中确定了 2010 年至 2018 年间接受腹腔镜胃底折叠术、食管裂孔疝修补术或 Heller 肌切开术的阿片类药物初治、成年患者。评估术前和术后的每日药物记录，以评估药物使用模式的变化。主要研究结果为持续性术后阿片类药物使用，定义为在 365 天随访时，阿片类药物处方覆盖的天数比例至少为 33%。使用对数二项式回归估计术后 365 天患者人口统计学信息和持续性术后阿片类药物使用的临床风险因素。
共有 17530 名患者符合纳入标准；6895 例行胃底折叠术，9235 例行食管裂孔疝修补术，1400 例行 Heller 肌切开术。9652 名患者在围手术期至少有一份阿片类药物处方。65 名患者（0.4%）在术后 365 天被发现有持续性术后阿片类药物使用。较低的 Charlson 合并症指数评分和精神疾病或物质使用障碍史对术后 365 天持续性术后阿片类药物使用的风险有统计学但无临床意义的保护作用。
只有一半接受微创、良性上消化道手术的阿片类药物初治患者在术后开具了阿片类药物处方。进展为持续性术后阿片类药物使用的风险小于 1%。这些发现支持了目前限制普通外科手术后开阿片类药物数量的指南。
