Division of Health Services Research, Department of Urology, University of Pittsburgh Medical Center, Kaufmann Medical Building 3471 Fifth Ave, Suite 700, Pittsburgh, PA 15213.
Division of Health Services Research, Department of Urology, University of Pittsburgh Medical Center, Kaufmann Medical Building 3471 Fifth Ave, Suite 700, Pittsburgh, PA 15213.
Urol Oncol. 2024 Jul;42(7):220.e21-220.e29. doi: 10.1016/j.urolonc.2024.03.010. Epub 2024 Apr 1.
To evaluate patient and provider characteristics that predict persistent opioid use following radical cystectomy for bladder cancer including non-opioid naïve patients.
Patients undergoing cystectomy between July 2007 and December 2015 were identified using the SEER-Medicare database. Opioid exposure was identified before and after cystectomy using Medicare Part D data. Multivariable analyses were used to identify predictors of the primary outcomes: persistent opioid use (prescription 3-6 months after surgery) and postoperative opioid prescriptions (within 30 days of surgery). Secondary outcomes included physician prescribing practices and rates of persistent opioid use in their patient cohorts.
A total of 1,774 patients were included; 29% had prior opioid exposure. Compared to opioid-naïve patients, non-opioid naïve patients were more frequently younger, Black, and living in less educated communities. The percentage of persistent postoperative use was 10% overall and 24% in non-opioid naïve patients. Adjusting for patient factors, opioid naïve individuals were less likely to develop persistent use (OR 0.23) while a 50-unit increase in oral morphine equivalent per day prescribed following surgery nearly doubled the likelihood of persistent use (OR 1.98). Practice factors such as hospital size, teaching affiliation, and hospital ownership failed to predict persistent use. 29% of patients filled an opioid prescription postoperatively. Opioid naïve patients (OR 0.13) and those cared for at government hospitals (OR 0.59) were less likely to fill an opioid script along with those residing in the Northeast. Variability between physicians was seen in prescribing practices and rates of persistent use.
Non-opioid naïve patients have higher rates of post-operative opioid prescription than opioid-naïve patients. Physician prescribing practices play a role in persistent use, as initial prescription amount predicts persistent use even in non-opioid naïve patients. Significant physician variation in both prescribing practices and rates of persistent use suggest a role for standardizing practices.
评估预测膀胱癌根治性膀胱切除术后持续使用阿片类药物的患者和提供者特征，包括非阿片类药物初治患者。
使用 SEER-Medicare 数据库确定 2007 年 7 月至 2015 年 12 月期间接受膀胱切除术的患者。使用医疗保险 D 部分数据确定手术前后的阿片类药物暴露情况。多变量分析用于确定主要结局的预测因素：持续使用阿片类药物（手术后 3-6 个月处方）和术后阿片类药物处方（手术后 30 天内）。次要结局包括医生在其患者群体中的处方实践和持续使用阿片类药物的比率。
共纳入 1774 例患者；29%有阿片类药物暴露史。与阿片类药物初治患者相比，非阿片类药物初治患者更年轻、黑人、居住在受教育程度较低的社区。总体而言，术后持续使用的百分比为 10%，非阿片类药物初治患者为 24%。调整患者因素后，阿片类药物初治患者发生持续使用的可能性较小（OR 0.23），而术后每天口服吗啡当量增加 50 个单位，持续使用的可能性几乎增加一倍（OR 1.98）。医院规模、教学附属机构和医院所有权等实践因素未能预测持续使用。29%的患者术后开具阿片类药物处方。阿片类药物初治患者（OR 0.13）和在政府医院接受治疗的患者（OR 0.59）以及居住在东北部的患者不太可能开阿片类药物处方，以及那些居住在东北部的患者。医生之间在处方实践和持续使用率方面存在差异。
非阿片类药物初治患者术后开具阿片类药物处方的比例高于阿片类药物初治患者。医生的处方实践在持续使用中起作用，因为初始处方量预测持续使用，即使在非阿片类药物初治患者中也是如此。在处方实践和持续使用率方面，医生之间存在显著差异，这表明需要标准化实践。
