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骨关节炎和脊柱疾病住院患者中阿片类药物的使用情况及医院结局

Opioid Utility and Hospital Outcomes Among Inpatients Admitted With Osteoarthritis and Spine Disorders.

作者信息

Lee Se Won, Werner Bryan, Nguyen Dan, Wang Charles, Kang Mingon, Ayutyanont Napatkamon, Lee Soohyoung

机构信息

From the Sunrise Health GME Consortium, HCA Healthcare, Las Vegas, Nevada (SWL, BW, DN, CW, NA); Department of Computer Science, University of Nevada, Las Vegas, Nevada (MK); and Yeshiva University, New York, New York (SL).

出版信息

Am J Phys Med Rehabil. 2023 Apr 1;102(4):353-359. doi: 10.1097/PHM.0000000000002101. Epub 2022 Sep 12.

Abstract

OBJECTIVE

The aim of the study is to evaluate opioid analgesic utilization and predictors for adverse events during hospitalization and discharge disposition among patients admitted with osteoarthritis or spine disorders.

DESIGN

This is a retrospective study of 12,747 adult patients admitted to six private community hospitals from 2017 to 2020. Opioid use during hospitalization and risk factors for hospital-acquired adverse events and nonhome discharge were investigated.

RESULTS

The total number of patients using opioids decreased; however, the daily morphine milligram equivalent use for patients on opioids increased from 2017 to 2020. Increased odds of nonhome discharge were associated with older age, Medicaid, Medicare insurance, and increased lengths of stay, increased body mass index, daily morphine milligram equivalent, and electrolyte replacement in the osteoarthritis group. In the spine group, older age, Black race, Medicaid, Medicare, no insurance, increased Charlson Comorbidity Index, lengths of stay, polypharmacy, and heparin use were associated with nonhome discharge. Adverse events were associated with increased age, lengths of stay, Medicare, polypharmacy, antiemetic, and benzodiazepine use in the osteoarthritis group and increased Charlson Comorbidity Index, lengths of stay, and electrolyte replacement in the spine group.

CONCLUSIONS

Despite the decreasing number of patients using opioids over the years, patients on opioids had an increased daily morphine milligram equivalent over the same period.

摘要

目的

本研究旨在评估骨关节炎或脊柱疾病患者住院期间及出院处置时阿片类镇痛药的使用情况及不良事件的预测因素。

设计

这是一项对2017年至2020年期间入住六家私立社区医院的12747例成年患者的回顾性研究。调查了住院期间阿片类药物的使用情况以及医院获得性不良事件和非家庭出院的危险因素。

结果

使用阿片类药物的患者总数有所下降;然而,2017年至2020年期间,使用阿片类药物的患者每日吗啡毫克当量使用量增加。在骨关节炎组中,非家庭出院几率增加与年龄较大、医疗补助、医疗保险、住院时间延长、体重指数增加、每日吗啡毫克当量以及电解质补充有关。在脊柱疾病组中,年龄较大、黑人种族、医疗补助、医疗保险、无保险、查尔森合并症指数增加、住院时间、多种药物治疗以及肝素使用与非家庭出院有关。在骨关节炎组中,不良事件与年龄增加、住院时间、医疗保险、多种药物治疗、止吐药和苯二氮䓬类药物使用有关;在脊柱疾病组中,不良事件与查尔森合并症指数增加、住院时间和电解质补充有关。

结论

尽管多年来使用阿片类药物的患者数量有所减少,但同期使用阿片类药物的患者每日吗啡毫克当量却有所增加。

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