Nozawa Kazutaka, Lin Yingsong, Ebata Nozomi, Wakabayashi Ryozo, Ushida Takahiro, Deie Masataka, Kikuchi Shogo
Department of Public Health, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
Medical Affairs, Pfizer Japan, Inc., Tokyo, Japan.
Drugs Real World Outcomes. 2023 Jun;10(2):331-340. doi: 10.1007/s40801-023-00363-5. Epub 2023 Mar 28.
Patients with chronic postsurgical pain are commonly prescribed opioids chronically because of refractory pain although chronic opioid use can cause various severe problems.
We aimed to investigate postoperative chronic opioid use and its association with perioperative pain management in patients who underwent a total knee arthroplasty in a Japanese real-world clinical setting.
We conducted a retrospective cohort study using an administrative claims database. We used a multivariate logistic regression analysis to examine the association between perioperative analgesic and anesthesia prescriptions and postoperative chronic opioid use. We calculated all-cause medication and medical costs for each patient.
Of the 23,537,431 patient records, 14,325 patients met the criteria and were included in the analyses. There were 5.4% of patients with postoperative chronic opioid use. Perioperative prescriptions of weak opioids, strong and weak opioids, and the αδ ligand were significantly associated with postoperative chronic opioid use (adjusted odds ratio [95% confidence interval], 7.22 [3.89, 13.41], 7.97 [5.07, 12.50], and 1.45 [1.13, 1.88], respectively). Perioperative combined prescriptions of general and local anesthesia were also significantly associated with postoperative chronic opioid use (3.37 [2.23, 5.08]). These medications and local anesthesia were more commonly prescribed on the day following surgery, after routinely used medications and general anesthesia were prescribed. The median total direct costs were approximately 1.3-fold higher among patients with postoperative chronic opioid use than those without postoperative chronic opioid use.
Patients who require supplementary prescription of analgesics for acute postsurgical pain are at high risk of postoperative chronic opioid use and these prescriptions should be given careful consideration to mitigate the patient burden.
尽管长期使用阿片类药物会引发各种严重问题，但慢性术后疼痛患者常因疼痛难治而长期服用阿片类药物。
我们旨在调查在日本真实临床环境中接受全膝关节置换术的患者术后长期使用阿片类药物的情况及其与围手术期疼痛管理的关联。
我们使用行政索赔数据库进行了一项回顾性队列研究。我们采用多变量逻辑回归分析来检验围手术期镇痛和麻醉处方与术后长期使用阿片类药物之间的关联。我们计算了每位患者的全因用药和医疗费用。
在23537431份患者记录中，14325名患者符合标准并纳入分析。有5.4%的患者术后长期使用阿片类药物。围手术期使用弱阿片类药物、强阿片类药物与弱阿片类药物联合使用以及αδ配体与术后长期使用阿片类药物显著相关（调整后的优势比[95%置信区间]分别为7.22[3.89,13.41]、7.97[5.07,12.50]和1.45[1.13,1.88]）。围手术期全身麻醉与局部麻醉联合处方也与术后长期使用阿片类药物显著相关（3.37[2.23,5.08]）。这些药物和局部麻醉在术后当天比常规使用的药物和全身麻醉更常被处方。术后长期使用阿片类药物的患者的总直接费用中位数比未术后长期使用阿片类药物的患者高出约1.3倍。
术后急性疼痛需要补充镇痛药物处方的患者术后长期使用阿片类药物的风险较高，应仔细考虑这些处方以减轻患者负担。
