Moura Steven P, Nicholson Showly, Hoftiezer Yannick Albert J, Lans Jonathan, Chen Neal C, Eberlin Kyle R
Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Mass.
Boston University School of Medicine, Boston, Mass.
Plast Reconstr Surg Glob Open. 2022 Apr 8;10(4):e4235. doi: 10.1097/GOX.0000000000004235. eCollection 2022 Apr.
Prolonged opioid use after surgery has been a contributing factor to the ongoing opioid epidemic. The purpose of this systematic review is to analyze the definitions of prolonged opioid use in prior literature and propose appropriate criteria to define postoperative prolonged opioid use in hand surgery.
Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines 130 studies were included for review. The primary outcome was the timepoint used to define prolonged opioid use following surgery. The proportion of patients with prolonged use and risk factors for prolonged use were also collected for each study. Included studies were categorized based on their surgical specialty.
The most common timepoint used to define prolonged opioid use was 3 months (n = 86, 67.2% of eligible definitions), ranging from 1 to 24 months. Although 11 of 12 specialties had a mean timepoint between 2.5 and 4.17 months, Spine surgery was the only outlier with a mean of 6.90 months. No correlation was found between the definition's timepoint and the rates of prolonged opioid use.
Although a vast majority of the literature reports similar timepoints to define prolonged postoperative opioid use, these studies often do not account for the type of procedures being performed. We propose that the definitions of postoperative prolonged opioid use should be tailored to the level and duration of pain for specific procedures. We present criteria to define prolonged opioid use in hand surgery.
术后长期使用阿片类药物一直是持续的阿片类药物流行的一个促成因素。本系统评价的目的是分析先前文献中术后长期使用阿片类药物的定义，并提出适用于手部手术中定义术后长期使用阿片类药物的标准。
根据系统评价和Meta分析的首选报告项目指南，纳入130项研究进行综述。主要结局是用于定义术后长期使用阿片类药物的时间点。还收集了每项研究中使用时间延长的患者比例和使用时间延长的危险因素。纳入的研究根据其外科专业进行分类。
用于定义长期使用阿片类药物的最常见时间点是3个月（n = 86，占符合条件定义的67.2%），范围为1至24个月。虽然12个专业中有11个的平均时间点在2.5至4.17个月之间，但脊柱手术是唯一的异常值，平均为6.90个月。未发现定义的时间点与长期使用阿片类药物的比率之间存在相关性。
虽然绝大多数文献报道了类似的时间点来定义术后长期使用阿片类药物，但这些研究往往没有考虑所进行手术的类型。我们建议，术后长期使用阿片类药物的定义应根据特定手术的疼痛程度和持续时间进行调整。我们提出了手部手术中定义长期使用阿片类药物的标准。
