Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
Reg Anesth Pain Med. 2024 Aug 5;49(8):602-608. doi: 10.1136/rapm-2023-104944.
BACKGROUND/IMPORTANCE: Considerable attention has been paid to identifying and mitigating perioperative opioid-related harms. However, rates of postsurgical opioid use disorder (OUD) and overdose, along with associated risk factors, have not been clearly defined.
Evaluate the evidence connecting perioperative opioid prescribing with postoperative OUD and overdose, compare these data with evidence from the addiction literature, discuss the clinical impact of these conditions, and make recommendations for further study.
State-of-the-art narrative review.
Nearly all evidence is from large retrospective studies of insurance claims and Veterans Health Administration (VHA) data. Incidence rates of new OUD within the first year after surgery ranged from 0.1% to 0.8%, while rates of overdose events ranged from 0.01% to 0.8%. Higher rates were seen among VHA patients, which may reflect differences in data completeness and/or risk factors. Identified risk factors included those related to substance use (preoperative opioid use; non-opioid substance use disorders; preoperative sedative, anxiolytic, antidepressant, and gabapentinoid use; and postoperative new persistent opioid use (NPOU)); demographic attributes (chiefly male sex, younger age, white race, and Medicaid or no insurance coverage); psychiatric comorbidities such as depression, bipolar disorder, and PTSD; and certain medical and surgical factors. Several challenges related to the use of administrative claims data were identified; there is a need for more granular retrospective studies and, ideally, prospective cohorts to assess postoperative OUD and overdose incidence with greater accuracy.
Retrospective data suggest an incidence of new postoperative OUD and overdose of up to 0.8% during the first year after surgery, but prospective studies are lacking.
背景/重要性：人们已经相当关注识别和减轻围手术期阿片类药物相关危害。然而，术后阿片类药物使用障碍（OUD）和过量的发生率以及相关的危险因素尚未明确界定。
评估围手术期阿片类药物处方与术后 OUD 和过量之间的关联证据，将这些数据与成瘾文献中的证据进行比较，讨论这些情况的临床影响，并提出进一步研究的建议。
最新的叙述性综述。
几乎所有证据都来自于针对保险索赔和退伍军人健康管理局（VHA）数据的大型回顾性研究。手术后第一年新发生 OUD 的发生率从 0.1%到 0.8%不等，而过量事件的发生率从 0.01%到 0.8%不等。VHA 患者的发生率较高，这可能反映了数据完整性和/或危险因素的差异。确定的危险因素包括与物质使用相关的因素（术前阿片类药物使用；非阿片类物质使用障碍；术前镇静剂、抗焦虑药、抗抑郁药和加巴喷丁类药物使用；以及术后新持续阿片类药物使用（NPOU））；人口统计学属性（主要是男性、年轻、白人种族和医疗补助或无保险覆盖）；精神共病，如抑郁、双相情感障碍和 PTSD；以及某些医疗和手术因素。确定了与使用行政索赔数据相关的一些挑战；需要更多的详细回顾性研究，理想情况下还需要前瞻性队列研究，以更准确地评估术后 OUD 和过量的发生率。
回顾性数据表明，术后第一年新发生 OUD 和过量的发生率高达 0.8%，但缺乏前瞻性研究。
