The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; MedStar Health Research Institute, Hyattsville, MD.
J Hand Surg Am. 2022 Nov;47(11):1068-1075. doi: 10.1016/j.jhsa.2022.06.026. Epub 2022 Aug 26.
Opioids play an important role in pain management after surgery but also increase the risk of prolonged opioid use in patients. The identification of patients who are more likely to use opioids after intended short-term treatment is critical for employing alternative management approaches or targeted interventions for the prevention of opioid-related problems. We used patient-reported data (PRD) and electronic health record information to identify factors predictive of prolonged opioid use after surgery.
We used our institutional registry containing data on all patients who underwent elective upper extremity surgeries. We evaluated factors associated with prolonged opioid use in the cohort from the year 2018 to 2019. We then validated our results using the 2020 cohort. The predictive variables included preoperative PRD and electronic health record data. Opioid use was determined based on patient reports and/or filled opioid prescriptions 3 months after surgery. We conducted bivariate regression, followed by multivariable regression analyses, and model validation using area under the receiver operating curve.
We included 2,114 patients. In our final model on the 2018-2019 electronic health records and PRD data (n = 1,589), including numerous patient-reported outcome questionnaire scores, patients who were underweight and had undergone trauma-related surgery had higher odds of being on opioids at 3 months. Additionally, each 5-unit decrease in the preoperative Patient-Reported Outcomes Measurement Information System Global Physical Health score was associated with a 30% increased odds of being on opioids at 3 months. The area under the receiver operating curve of our model was 70.4%. On validation using data from the 2020 cohort, the area under the receiver operating curve was 60.3%. The Hosmer-Lemeshow test indicated a good fit.
We found that preoperative questionnaire scores were associated with prolonged postoperative opioid use, independent of other variables. Furthermore, PRD may provide unique patient-level insights, alongside other factors, to improve our understanding of postsurgical pain management.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
阿片类药物在术后疼痛管理中起着重要作用，但也会增加患者长期使用阿片类药物的风险。识别那些在预期短期治疗后更有可能使用阿片类药物的患者，对于采用替代管理方法或针对预防阿片类药物相关问题的靶向干预至关重要。我们使用患者报告数据（PRD）和电子健康记录信息来确定与手术后长期使用阿片类药物相关的因素。
我们使用包含所有接受择期上肢手术患者数据的机构注册表。我们评估了 2018 年至 2019 年队列中与长期使用阿片类药物相关的因素。然后，我们使用 2020 年队列验证了我们的结果。预测变量包括术前 PRD 和电子健康记录数据。根据患者报告和/或术后 3 个月填写的阿片类药物处方来确定阿片类药物的使用情况。我们进行了双变量回归，然后进行了多变量回归分析，并使用接受者操作特征曲线下的面积进行了模型验证。
我们纳入了 2114 名患者。在我们对 2018-2019 年电子健康记录和 PRD 数据（n=1589）的最终模型中，包括许多患者报告的结果问卷评分，体重不足和经历过创伤相关手术的患者在术后 3 个月使用阿片类药物的几率更高。此外，术前患者报告的测量信息系统全球身体健康评分每降低 5 个单位，与术后 3 个月使用阿片类药物的几率增加 30%相关。我们模型的接受者操作特征曲线下面积为 70.4%。在使用 2020 年队列数据进行验证时，接受者操作特征曲线下面积为 60.3%。Hosmer-Lemeshow 检验表明拟合良好。
我们发现，术前问卷评分与术后长期使用阿片类药物相关，独立于其他变量。此外，PRD 可能会提供独特的患者层面的见解，以及其他因素，以提高我们对术后疼痛管理的理解。
研究类型/证据水平：预后 II 级。
