Geisel School of Medicine at Dartmouth, Hanover, NH.
Dartmouth-Hitchcock Medical Center Analytics Institute, Lebanon, NH.
Ann Surg. 2022 Sep 1;276(3):e192-e198. doi: 10.1097/SLA.0000000000005546. Epub 2022 Jul 28.
To determine: (1) incidence of " opioid never events " ( ONEs ), defined as the development of opioid dependence or overdose in an opioid-naive surgical patient who is prescribed opioids postoperatively and (2) risk factors predicting ONEs.
Patients receiving opioids after surgery are at risk of experiencing life-threatening opioid-related adverse events.
An electronic medical record review identified surgical patients at an academic medical center between January 1, 2015, and December 31, 2018, followed through March 31, 2020. ONEs were determined by International Classification of Diseases, Ninth/10th Revision (ICD-9/10) codes, and electronic medical record review.
A total of 35,335 opioid-naive surgical patients received a perioperative opioid prescription. The median follow-up was 3.47 years (range: 1.25-5.25 years). ONEs occurred in 0.19% (67/35,335) of patients. The ONE rate was 5.6 per 10,000 person-years of follow-up. Ten of 67 ONE patients overdosed on opioids. The median time to ONE was 1.6 years; the highest ONE rate was observed 1 to 2 years after surgery. In multivariate analysis, patients receiving opioid prescriptions 90 to 180 or 90 to 360 days after surgery had the highest risk of developing ONEs [hazard ratio (HR)=6.39, confidence interval (CI): 3.72-10.973; HR=6.87, CI: 4.24-11.12, respectively]. Surgical specialty (HR=5.21, 2.65-0.23) and patient age (HR=4.17, CI: 2.50-6.96) were also risk factors for ONEs. Persistent opioid use 90 to 360 days after surgery was present in 45% of patients developing ONEs.
Postoperative opioid dependence or overdose is a significant health problem, affecting roughly 2 per 1000 opioid-naive surgical patients prescribed an opioid and followed for 5 years. Risk factors for the development of ONEs include opioid use 3 to 12 months after surgery, patient age, and surgical procedure.
确定：（1）“阿片类药物从未发生事件”（ONEs）的发生率，定义为接受阿片类药物治疗的手术患者在术后接受阿片类药物处方后出现阿片类药物依赖或过量的情况，以及（2）预测 ONEs 的风险因素。
接受手术后阿片类药物的患者有发生危及生命的阿片类药物相关不良事件的风险。
通过电子病历回顾，确定了 2015 年 1 月 1 日至 2018 年 12 月 31 日期间在学术医疗中心接受手术的患者，并随访至 2020 年 3 月 31 日。通过国际疾病分类，第九/第十版（ICD-9/10）代码和电子病历回顾确定了 ONEs。
共有 35335 名阿片类药物初治手术患者接受了围手术期阿片类药物处方。中位随访时间为 3.47 年（范围：1.25-5.25 年）。在 67 名患者（35335 名患者中的 0.19%）中发生了 ONEs。ONE 的发生率为每 10000 人年随访 5.6 例。在 67 名 ONE 患者中有 10 名发生阿片类药物过量。ONE 的中位时间为 1.6 年；术后 1 至 2 年观察到最高的 ONE 发生率。多变量分析显示，术后 90 至 180 天或 90 至 360 天接受阿片类药物处方的患者发生 ONEs 的风险最高[风险比（HR）=6.39，置信区间（CI）：3.72-10.973；HR=6.87，CI：4.24-11.12]。手术专业（HR=5.21，2.65-0.23）和患者年龄（HR=4.17，CI：2.50-6.96）也是 ONEs 的危险因素。在发生 ONEs 的患者中，有 45%在术后 90 至 360 天持续使用阿片类药物。
术后阿片类药物依赖或过量是一个严重的健康问题，大约影响了 2000 名接受阿片类药物治疗并随访 5 年的阿片类药物初治手术患者中的 2 名。ONE 发展的危险因素包括术后 3 至 12 个月的阿片类药物使用、患者年龄和手术程序。
