Nasser Khadija, Verhoeff Kevin, Mocanu Valentin, Kung Janice Y, Purich Kieran, Switzer Noah J, Birch Daniel W, Karmali Shahzeer
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Department of Surgery, University of Alberta, Edmonton, AB, Canada.
Surg Endosc. 2023 Jan;37(1):703-714. doi: 10.1007/s00464-022-09291-x. Epub 2022 May 9.
Increasing evidence suggests surgical patients are at risk for developing new, persistent opioid use (NPOU) following surgery. This risk may be heightened for patients undergoing bariatric surgery. Few studies have evaluated this important long-term outcome and little is known about the rate of NPOU, or factors associated with NPOU for bariatric surgery patients.
We conducted a systematic review of MEDLINE, Embase, Scopus, Web of Science, and Cochrane databases in August 2021. Studies were reviewed and data extracted independently by two reviewers following MOOSE guidelines. Studies evaluating bariatric surgery patients reporting NPOU, defined as new opioid use > 90 days after surgery, were included. Abstracts, non-English, animal, n < 5, and pediatric studies were excluded. Primary outcome was NPOU prevalence, and secondary outcomes were patient and surgical factors associated with NPOU. Factors associated with NPOU are reported from findings of individual studies; meta-analysis could not be completed due to heterogeneity of reporting.
We retrieved a total of 2113 studies with 8 meeting inclusion criteria. In studies reporting NPOU rates (n = 4 studies), pooled prevalence was 6.0% (95% CI 4.0-7.0%). Patient characteristics reported by studies to be associated with NPOU included prior substance use (tobacco, alcohol, other prescription analgesics), preoperative mental health disorder (anxiety, mood disorders, eating disorders), and public health insurance. Surgical factors associated with NPOU included severe post-operative complications and in-hospital opioid use (peri- or post operatively).
NPOU is an uncommon but important complication following bariatric surgery, with patient factors including prior substance abuse, mental health disorders, and use of public health insurance placing patients at increased risk, and surgical factors being complications and peri-operative opioid use. Studies evaluating techniques to reduce NPOU in these high-risk populations are needed.
越来越多的证据表明，外科手术患者术后有出现新的持续性阿片类药物使用（NPOU）的风险。对于接受减肥手术的患者，这种风险可能更高。很少有研究评估这一重要的长期结果，对于减肥手术患者的NPOU发生率或与之相关的因素知之甚少。
我们于2021年8月对MEDLINE、Embase、Scopus、科学网和考科蓝数据库进行了系统综述。两名评审员按照MOOSE指南独立审查研究并提取数据。纳入评估减肥手术患者报告NPOU情况的研究，NPOU定义为术后90天以上新使用阿片类药物。排除摘要、非英文、动物、样本量小于5以及儿科研究。主要结局是NPOU患病率，次要结局是与NPOU相关的患者和手术因素。与NPOU相关的因素根据各研究结果报告；由于报告的异质性，无法完成荟萃分析。
我们共检索到2113项研究，其中8项符合纳入标准。在报告NPOU发生率的研究中（n = 4项研究），合并患病率为6.0%（95%置信区间4.0 - 7.0%）。研究报告的与NPOU相关的患者特征包括既往物质使用（烟草、酒精、其他处方镇痛药）、术前精神健康障碍（焦虑、情绪障碍、饮食失调）以及公共医疗保险。与NPOU相关的手术因素包括严重术后并发症和住院期间阿片类药物使用（围手术期或术后）。
NPOU是减肥手术后一种不常见但重要的并发症，患者因素包括既往药物滥用、精神健康障碍以及使用公共医疗保险会使患者风险增加，手术因素为并发症和围手术期阿片类药物使用。需要开展研究评估降低这些高危人群NPOU的技术。
