Center for Clinical Epidemiology, Odense University Hospital, and Research Unit of Clinical Epidemiology, University of Southern Denmark, Sdr. Boulevard 29, entrance 219, ground floor, 5000, Odense, Denmark.
Spine Centre of Southern Denmark, Lillebaelt Hospital, University Hospital of Southern Denmark, Middelfart, Denmark.
Eur Spine J. 2023 Dec;32(12):4444-4451. doi: 10.1007/s00586-023-07901-3. Epub 2023 Aug 31.
This study based exclusively on register-data provides a scientific basis for further research on the use of opioids in patients with degenerative back disorder. The main objective of this study is to investigate whether surgically treated back pain patients have the same risk of being long-term opioid users as back pain patients who did not have surgery.
We performed a retrospective register-based cohort study based on all patients diagnosed with a degenerative back disorder at the Spine Center of Southern Denmark from 2011 to 2017. The primary outcome of the study was the use of opioids two years after the patient's first hospital contact with a degenerative back condition. Fisher exact tests were used for descriptive analyses. The effect of the surgery was estimated using adjusted logistic regression analyses.
For patients who used opioids before the first hospital contact, the ratio for long-term opioid use for surgically treated patients is significantly lower than for non-surgically treated patients (OR = 0.75, 95%CI (0.66; 0.86)). For patients who did not use opioids before, the ratio for long-term opioid use for surgically treated patients does not differ from that of non-surgically treated patients (OR = 1.01, 95%CI (0.84; 1.22)).
Patients with a degenerative back disorder who used opioids before their first visit to a specialized spine center have a lower risk of becoming long-term opioid users if they were surgically treated. Whereas for patients who did not use opioids before the first visit, surgical treatment does not influence the risk of becoming long-term opioid users.
本研究仅基于登记数据，为进一步研究退行性腰疾患者中阿片类药物的使用提供了科学依据。本研究的主要目的是调查接受手术治疗的腰痛患者是否与未接受手术的腰痛患者一样，长期使用阿片类药物的风险相同。
我们对 2011 年至 2017 年期间在丹麦南部脊柱中心诊断为退行性腰疾的所有患者进行了回顾性基于登记的队列研究。该研究的主要结局为患者首次因退行性腰疾住院后两年内使用阿片类药物的情况。采用 Fisher 确切检验进行描述性分析。采用调整后的逻辑回归分析评估手术的效果。
对于首次住院前使用阿片类药物的患者，手术治疗患者长期使用阿片类药物的比例明显低于非手术治疗患者（OR=0.75，95%CI（0.66；0.86））。对于首次住院前未使用阿片类药物的患者，手术治疗患者长期使用阿片类药物的比例与非手术治疗患者无差异（OR=1.01，95%CI（0.84；1.22））。
首次就诊于专门脊柱中心的退行性腰疾患者，如果在首次就诊前使用过阿片类药物，那么接受手术治疗的患者成为长期阿片类药物使用者的风险较低。而对于首次就诊前未使用过阿片类药物的患者，手术治疗并不影响成为长期阿片类药物使用者的风险。
